Healthcare Provider Details

I. General information

NPI: 1730132986
Provider Name (Legal Business Name): BARBARA BRIDGEN VICTOR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12601 GARDEN GROVE BLVD
GARDEN GROVE CA
92843-1908
US

IV. Provider business mailing address

2100 POWELL STREET SUITE 900
EMERYVILLE CA
94608-1803
US

V. Phone/Fax

Practice location:
  • Phone: 714-537-5160
  • Fax:
Mailing address:
  • Phone: 510-350-2658
  • Fax: 510-879-9086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA64519
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: