Provider Demographics
NPI:1326584236
Name:VICTORIA MEDICAL, INC.
Entity Type:Organization
Organization Name:VICTORIA MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:XANTHE
Authorized Official - Middle Name:
Authorized Official - Last Name:VICTORIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-735-8762
Mailing Address - Street 1:5451 LA PALMA AVE STE 15
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1758
Mailing Address - Country:US
Mailing Address - Phone:714-735-8762
Mailing Address - Fax:714-735-8762
Practice Address - Street 1:5451 LA PALMA AVE STE 15
Practice Address - Street 2:
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1758
Practice Address - Country:US
Practice Address - Phone:714-735-8762
Practice Address - Fax:714-735-8762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-16
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94865207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A948650Medicaid
CAI68611Medicare UPIN