Provider Demographics
NPI:1528386042
Name:VICTORY BUSINESS ASSOCIATES, INC.
Entity Type:Organization
Organization Name:VICTORY BUSINESS ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:FLORENCE
Authorized Official - Middle Name:B
Authorized Official - Last Name:ADEMOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-755-4126
Mailing Address - Street 1:7868 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-2727
Mailing Address - Country:US
Mailing Address - Phone:310-755-4126
Mailing Address - Fax:
Practice Address - Street 1:7868 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-2727
Practice Address - Country:US
Practice Address - Phone:310-755-4126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization