Healthcare Provider Details

I. General information

NPI: 1285968370
Provider Name (Legal Business Name): VICTORIA SHOKO DIVIS MCDONALD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2009
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MERCY CIRCLE GENERAL SURGERY CLINIC
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

PO BOX 555191
CAMP PENDLETON CA
92055-5191
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-1356
  • Fax: 760-725-0117
Mailing address:
  • Phone: 760-725-1356
  • Fax: 760-725-0117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01068547A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: