Healthcare Provider Details

I. General information

NPI: 1760434005
Provider Name (Legal Business Name): VICTORIA ALAEV M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12157 VICTORY BLVD.
NORTH HOLLYWOOD CA
91606-0000
US

IV. Provider business mailing address

12157 VICTORY BLVD.
NORTH HOLLYWOOD CA
91606-0000
US

V. Phone/Fax

Practice location:
  • Phone: 818-755-8000
  • Fax: 818-755-8006
Mailing address:
  • Phone: 818-755-8000
  • Fax: 818-755-8006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA78360
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: