Provider Demographics
NPI:1609146828
Name:ALTREE, VICTORIA ANN (MD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ANN
Last Name:ALTREE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 VERDUGO BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1402
Mailing Address - Country:US
Mailing Address - Phone:818-790-0914
Mailing Address - Fax:818-790-2816
Practice Address - Street 1:1809 VERDUGO BLVD STE 200
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1402
Practice Address - Country:US
Practice Address - Phone:818-790-0914
Practice Address - Fax:818-790-2816
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-04
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG127682207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILBA4086559OtherSTATE LICENSE
CAG127682OtherSTATE LICENSE