Healthcare Provider Details

I. General information

NPI: 1023420924
Provider Name (Legal Business Name): AIMEE VICTORIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2014
Last Update Date: 05/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 HERNDON AVE
CLOVIS CA
93611-6813
US

IV. Provider business mailing address

2691 CHESTNUT ST
HANFORD CA
93230-1286
US

V. Phone/Fax

Practice location:
  • Phone: 559-299-4264
  • Fax: 559-299-1421
Mailing address:
  • Phone: 559-299-2578
  • Fax: 559-299-1421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number26115
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: