| Victoria Medical, Inc. | |
|
5451 La Palma Ave Ste 15 La Palma CA 90623-1758 | |
| (714) 735-8762 | |
| (714) 735-8762 |
| Full Name | Victoria Medical, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 5451 La Palma Ave Ste 15, La Palma, California |
| Authorized Official Name and Position | Xanthe Victoria (CEO) |
| Authorized Official Contact | 7147358762 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Victoria Medical, Inc. 5451 La Palma Ave Ste 15 La Palma CA 90623-1758 Ph: (714) 735-8762 | Victoria Medical, Inc. 5451 La Palma Ave Ste 15 La Palma CA 90623-1758 Ph: (714) 735-8762 |
| NPI Number | 1326584236 |
|---|---|
| Provider Enumeration Date | 01/16/2017 |
| Last Update Date | 01/16/2017 |
| Medicare PECOS PAC ID | 5193085629 |
|---|---|
| Medicare Enrollment ID | O20180201001345 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326584236 | NPI | - | NPPES |
| 00A948650 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | A94865 (California) | Primary |
| Provider Name | Xanthe Victoria |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447270418 PECOS PAC ID: 0547362964 Enrollment ID: I20070302000262 |
| Provider Name | Rafaelito S Victoria |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548363989 PECOS PAC ID: 1759405319 Enrollment ID: I20100902000983 |
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