Healthcare Provider Details

I. General information

NPI: 1689506024
Provider Name (Legal Business Name): VICTORY PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 E BASELINE RD STE 118
TEMPE AZ
85283-1269
US

IV. Provider business mailing address

209 E BASELINE RD STE 118
TEMPE AZ
85283-1269
US

V. Phone/Fax

Practice location:
  • Phone: 818-601-8016
  • Fax:
Mailing address:
  • Phone: 818-601-8016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE BARCELON
Title or Position: ADMIN
Credential:
Phone: 818-601-8016