Healthcare Provider Details

I. General information

NPI: 1073074076
Provider Name (Legal Business Name): VICTORIA EBY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2019
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8630 E VIA DE VENTURA
SCOTTSDALE AZ
85258-3326
US

IV. Provider business mailing address

8630 E VIA DE VENTURA STE 105
SCOTTSDALE AZ
85258-3340
US

V. Phone/Fax

Practice location:
  • Phone: 480-889-1838
  • Fax:
Mailing address:
  • Phone: 480-889-1838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number009249
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberBP10081498
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: