# VICTORINA'S DIABETES ENDOCRINOLOGY AND METABOLISM, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972050235
- **Authorized official:** DR. WILFRED MARCO VICTORINA M.D. (PRESIDENT)
- **Authorized official phone:** (859) 496-1803

## Contact information

- **Practice address:** 4879 PALM COAST PKWY NW, UNIT \# 2, PALM COAST, FL 32137-3672
- **Practice address phone:** (386) 225-4462
- **Mailing address:** PO BOX 350812, PALM COAST, FL 32135-0812
- **Mailing address phone:** (386) 225-4462
- **Mailing address fax:** (386) 225-4465

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | ME126126 | FL | Yes |

## Other

- **Enumeration date:** 09/04/2016
- **Last updated:** 04/06/2017