Provider Demographics
NPI:1558807024
Name:VICTORIANO, ALLAIN JULIAN CAMANAG (RN, PHN, AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:ALLAIN JULIAN
Middle Name:CAMANAG
Last Name:VICTORIANO
Suffix:
Gender:M
Credentials:RN, PHN, AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15723 THORNLAKE AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-6768
Mailing Address - Country:US
Mailing Address - Phone:562-275-5860
Mailing Address - Fax:
Practice Address - Street 1:9862 CHAPMAN AVE STE B
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-2726
Practice Address - Country:US
Practice Address - Phone:714-620-7001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-09
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95173882163WG0000X
CA390200000X
CA95026004363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program