Provider Demographics
NPI:1740753896
Name:DEAN, VICTORIA S (CPM)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:S
Last Name:DEAN
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 S 50TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-1658
Mailing Address - Country:US
Mailing Address - Phone:505-316-5498
Mailing Address - Fax:
Practice Address - Street 1:805 S SAINT BERNARD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-3308
Practice Address - Country:US
Practice Address - Phone:505-316-5498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDEM-LD-10196213176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife