Provider Demographics
NPI:1093102964
Name:VICTORIA, RODOLFO (PHD)
Entity Type:Individual
Prefix:DR
First Name:RODOLFO
Middle Name:
Last Name:VICTORIA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3642 E 61ST PL
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-3231
Mailing Address - Country:US
Mailing Address - Phone:323-810-6840
Mailing Address - Fax:
Practice Address - Street 1:1000 WILSHIRE BLVD
Practice Address - Street 2:#240
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-2457
Practice Address - Country:US
Practice Address - Phone:424-201-1600
Practice Address - Fax:424-201-1601
Is Sole Proprietor?:No
Enumeration Date:2015-04-18
Last Update Date:2015-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27039103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling