Provider Demographics
NPI:1194100024
Name:VICTOR TOTFALUSI DO P.A
Entity type:Organization
Organization Name:VICTOR TOTFALUSI DO P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:TOTFALUSI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-993-7029
Mailing Address - Street 1:3157 N UNIVERSITY DR STE 107
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-2258
Mailing Address - Country:US
Mailing Address - Phone:954-990-0595
Mailing Address - Fax:954-990-0596
Practice Address - Street 1:18459 PINES BLVD STE 213
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-1400
Practice Address - Country:US
Practice Address - Phone:954-990-0595
Practice Address - Fax:954-990-0596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10987174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004412700Medicaid
FL14JE7OtherBCBS
FL348598OtherAVMED
FL004412700Medicaid