Basic Information
| Provider Information | |||||||||
| NPI: | 1184601304 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VINAS | ||||||||
| FirstName: | FEDERICO | ||||||||
| MiddleName: | CARLOS | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 311 N CLYDE MORRIS BLVD | ||||||||
| Address2: | SUITE 560 | ||||||||
| City: | DAYTONA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321142781 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3864257644 | ||||||||
| FaxNumber: | 3862382224 | ||||||||
| Practice Location | |||||||||
| Address1: | 311 N CLYDE MORRIS BLVD | ||||||||
| Address2: | STE 560 | ||||||||
| City: | DAYTONA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321142781 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3864257644 | ||||||||
| FaxNumber: | 3862382224 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2005 | ||||||||
| LastUpdateDate: | 11/16/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | ME0080371 | FL | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 2359550 | 01 | AETNA HMO | OTHER | 258752100 | 05 | FL | MEDICAID | 7119164 | 01 | AETNA PPO | OTHER | 51893 | 01 | BLUE CROSS | OTHER |