Healthcare Provider Details

I. General information

NPI: 1619499142
Provider Name (Legal Business Name): VICTORIA HIRST FNP-BC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2017
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 N SEPULVEDA BLVD
MANHATTAN BEACH CA
90266-2730
US

IV. Provider business mailing address

1128 OCEAN PARK BLVD APT 101
SANTA MONICA CA
90405-4764
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone: 951-733-3079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number826283
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95008849
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: