Provider Demographics
NPI:1295784247
Name:VICTORIA MEDICAL & REHABILITATION ASSOCIATES, P.A.
Entity type:Organization
Organization Name:VICTORIA MEDICAL & REHABILITATION ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:BAQUIRAN
Authorized Official - Last Name:VELASCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-575-3775
Mailing Address - Street 1:601 E SAN ANTONIO ST
Mailing Address - Street 2:STE. 503W
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-6004
Mailing Address - Country:US
Mailing Address - Phone:361-575-3775
Mailing Address - Fax:
Practice Address - Street 1:601 E SAN ANTONIO ST
Practice Address - Street 2:STE. 503W
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-6004
Practice Address - Country:US
Practice Address - Phone:361-575-3775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6733208100000X
TXK6734207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX081249701Medicaid
TX00843NMedicare PIN