Provider Demographics
NPI:1710375399
Name:VICTORIA, NORMAN VINCENT
Entity Type:Individual
Prefix:
First Name:NORMAN VINCENT
Middle Name:
Last Name:VICTORIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 N TRAVIS AVE
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:TX
Mailing Address - Zip Code:76520-1665
Mailing Address - Country:US
Mailing Address - Phone:254-697-7118
Mailing Address - Fax:254-697-7173
Practice Address - Street 1:2202 N TRAVIS AVE
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:TX
Practice Address - Zip Code:76520-1665
Practice Address - Country:US
Practice Address - Phone:254-697-7118
Practice Address - Fax:254-697-7173
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112563225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist