Provider Demographics
NPI:1336584853
Name:EBIANA, VICTORIA (MD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:EBIANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36300 SPICEBUSH LN
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-5062
Mailing Address - Country:US
Mailing Address - Phone:440-759-6142
Mailing Address - Fax:
Practice Address - Street 1:710 WESTWOOD PLZ
Practice Address - Street 2:ROOM 1-240
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-1769
Practice Address - Country:US
Practice Address - Phone:310-825-6681
Practice Address - Fax:310-206-4733
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-10
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program