Healthcare Provider Details

I. General information

NPI: 1649199407
Provider Name (Legal Business Name): VICTOR JOSEPH LASLEY RC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9826 18TH AVE
BLYTHE CA
92225-9229
US

IV. Provider business mailing address

380 S 1ST ST
BLYTHE CA
92225-2819
US

V. Phone/Fax

Practice location:
  • Phone: 760-922-8625
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: