Healthcare Provider Details

I. General information

NPI: 1952143232
Provider Name (Legal Business Name): VICTORIA PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 06/10/2024
Certification Date: 06/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 S ROBERTSON BLVD
BEVERLY HILLS CA
90211-3602
US

IV. Provider business mailing address

14249 DICKENS ST APT 107
SHERMAN OAKS CA
91423-4252
US

V. Phone/Fax

Practice location:
  • Phone: 310-273-6600
  • Fax:
Mailing address:
  • Phone: 310-775-1404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95022327
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95158166
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: