Healthcare Provider Details

I. General information

NPI: 1184777922
Provider Name (Legal Business Name): CLINICA LA VICTORIA A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2303 S UNION AVE SUITE C2
BAKERSFIELD CA
93307-4677
US

IV. Provider business mailing address

2303 S UNION AVE SUITE C2
BAKERSFIELD CA
93307-4677
US

V. Phone/Fax

Practice location:
  • Phone: 661-885-7007
  • Fax: 661-735-3699
Mailing address:
  • Phone: 661-885-7007
  • Fax: 661-735-3699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA61306
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: JUAN CORONA
Title or Position: PROVIDER
Credential: P.A.C.
Phone: 661-885-7007