Provider Demographics
NPI:1679860654
Name:SOEKAMTO, VICTORIA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:SOEKAMTO
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9573 GARVEY AVE
Mailing Address - Street 2:SUITE #17
Mailing Address - City:S. EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91733-4606
Mailing Address - Country:US
Mailing Address - Phone:626-454-1801
Mailing Address - Fax:626-454-2203
Practice Address - Street 1:9573 GARVEY AVE.
Practice Address - Street 2:SUITE #17
Practice Address - City:S. EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-4606
Practice Address - Country:US
Practice Address - Phone:626-454-1801
Practice Address - Fax:626-454-2203
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CANP20011207Y00000X, 208000000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics