Healthcare Provider Details

I. General information

NPI: 1679496400
Provider Name (Legal Business Name): VICTORIA BOUSHERI
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 22713
OAKLAND CA
94609-5313
US

IV. Provider business mailing address

PO BOX 22713
OAKLAND CA
94609-5313
US

V. Phone/Fax

Practice location:
  • Phone: 626-383-4824
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number139841
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: