Healthcare Provider Details

I. General information

NPI: 1205744406
Provider Name (Legal Business Name): VICTORIOUSLY MADE WELLNESS AND NURSING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2026
Last Update Date: 08/29/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5521 BODEN ST
LOS ANGELES CA
90016-3201
US

IV. Provider business mailing address

5521 BODEN ST
LOS ANGELES CA
90016-3201
US

V. Phone/Fax

Practice location:
  • Phone: 323-495-2676
  • Fax:
Mailing address:
  • Phone: 323-495-2676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA ESSO GAGO
Title or Position: OWNER
Credential: DNP, PMHNP-BC
Phone: 323-495-2676