Provider Demographics
NPI:1790476489
Name:VICTORIA, LAURA DENISE
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:DENISE
Last Name:VICTORIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:DENISE
Other - Last Name:ESTRADA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3148 MIDWAY DR STE 113
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-4539
Mailing Address - Country:US
Mailing Address - Phone:619-363-0853
Mailing Address - Fax:619-362-9905
Practice Address - Street 1:3148 MIDWAY DR # 113
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-4539
Practice Address - Country:US
Practice Address - Phone:619-363-0853
Practice Address - Fax:619-362-9905
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information