Provider Demographics
NPI:1760418537
Name:ADAMS, VICTORIA
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 SAN MIGUEL DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7829
Mailing Address - Country:US
Mailing Address - Phone:949-644-6050
Mailing Address - Fax:949-644-4427
Practice Address - Street 1:360 SAN MIGUEL DR
Practice Address - Street 2:SUITE 302
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7829
Practice Address - Country:US
Practice Address - Phone:949-644-6050
Practice Address - Fax:949-644-4427
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3046225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1679518716OtherGRP NPI
CA5213930001Medicare NSC
CAOT3046Medicare PIN