Healthcare Provider Details

I. General information

NPI: 1477274215
Provider Name (Legal Business Name): VICTORIA VASCO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2022
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E DOMINGUEZ ST STE 110
CARSON CA
90746-3615
US

IV. Provider business mailing address

926 W PALM AVE
BURBANK CA
91506-2018
US

V. Phone/Fax

Practice location:
  • Phone: 310-830-4561
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number95020466
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number95020466
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number95020466
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95020466
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: