Healthcare Provider Details

I. General information

NPI: 1043305618
Provider Name (Legal Business Name): VICTOR VITALY STRELZOW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16300 SAND CANYON AVE SUITE 704
IRVINE CA
92618
US

IV. Provider business mailing address

16300 SAND CANYON AVE SUITE 704
IRVINE CA
92618
US

V. Phone/Fax

Practice location:
  • Phone: 949-753-9299
  • Fax: 949-753-7417
Mailing address:
  • Phone: 949-753-9299
  • Fax: 949-753-7417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA32942
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: