Healthcare Provider Details

I. General information

NPI: 1336584853
Provider Name (Legal Business Name): VICTORIA EBIANA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2013
Last Update Date: 06/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 WESTWOOD PLZ ROOM 1-240
LOS ANGELES CA
90095-1769
US

IV. Provider business mailing address

36300 SPICEBUSH LN
SOLON OH
44139-5062
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-6681
  • Fax: 310-206-4733
Mailing address:
  • Phone: 440-759-6142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: