Healthcare Provider Details

I. General information

NPI: 1942845847
Provider Name (Legal Business Name): VICTORIA JESSICA VANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 11/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 SHAW AVE STE 101
CLOVIS CA
93611-4096
US

IV. Provider business mailing address

1541 MCKELVY AVE
CLOVIS CA
93611-5964
US

V. Phone/Fax

Practice location:
  • Phone: 559-900-1288
  • Fax:
Mailing address:
  • Phone: 559-393-0709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF10190472
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: