Provider Demographics
NPI:1033746904
Name:AMOSCATO, VICTORIA NOEL (LAC)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:NOEL
Last Name:AMOSCATO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MS
Other - First Name:TORI
Other - Middle Name:NOEL
Other - Last Name:AMOSCATO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:646 TULAROSA DR APT 3
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-3655
Mailing Address - Country:US
Mailing Address - Phone:323-240-2788
Mailing Address - Fax:
Practice Address - Street 1:1551 COLORADO BLVD STE 104
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-1456
Practice Address - Country:US
Practice Address - Phone:213-807-3328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17692171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist