Provider Demographics
NPI:1841319639
Name:HAZARD, VICTORIA MARIE
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:MARIE
Last Name:HAZARD
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:VICTORIA
Other - Middle Name:MARIE
Other - Last Name:HART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:24575 LOWE DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-4123
Mailing Address - Country:US
Mailing Address - Phone:760-580-6836
Mailing Address - Fax:
Practice Address - Street 1:3851 ROSECRANS ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3115
Practice Address - Country:US
Practice Address - Phone:619-692-5588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF255074163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult