Provider Demographics
NPI:1114129640
Name:TOBON, VICTORIA EUGENIA (MD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:EUGENIA
Last Name:TOBON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:EUGENIA
Other - Last Name:GREENWALT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:16180 W SUNSET BLVD
Mailing Address - Street 2:#C
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-3438
Mailing Address - Country:US
Mailing Address - Phone:310-613-7949
Mailing Address - Fax:
Practice Address - Street 1:16180 W SUNSET BLVD
Practice Address - Street 2:#C
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-3438
Practice Address - Country:US
Practice Address - Phone:310-613-7949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG86602207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology