| Victorious Health Llc | |
|
10400 Griffin Rd Ste 107 Davie FL 33328-3320 | |
| (786) 697-0703 | |
| Not Available |
| Full Name | Victorious Health Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 10400 Griffin Rd Ste 107, Davie, Florida |
| Authorized Official Name and Position | Isabelo Ian Domingo Victorio (OWNER/CEO) |
| Authorized Official Contact | 9048662947 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Victorious Health Llc 5965 Stirling Rd # 391 Davie FL 33314-7225 Ph: (904) 866-2947 | Victorious Health Llc 10400 Griffin Rd Ste 107 Davie FL 33328-3320 Ph: (786) 697-0703 |
| NPI Number | 1154002855 |
|---|---|
| Provider Enumeration Date | 07/26/2023 |
| Last Update Date | 05/05/2025 |
| Medicare PECOS PAC ID | 7315477163 |
|---|---|
| Medicare Enrollment ID | O20250207002406 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154002855 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Primary |
| Provider Name | Isabelo Ian Victorio |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841797842 PECOS PAC ID: 6800130063 Enrollment ID: I20181129001794 |
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