Provider Demographics
NPI:1073075008
Name:BLOSSMAN, VICTORIA REYES (DO)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:REYES
Last Name:BLOSSMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 669379
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-9379
Mailing Address - Country:US
Mailing Address - Phone:985-898-4493
Mailing Address - Fax:
Practice Address - Street 1:82525 HIGHWAY 25
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:LA
Practice Address - Zip Code:70437-6111
Practice Address - Country:US
Practice Address - Phone:985-898-4001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-31
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA327751207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1073075008Medicaid