Healthcare Provider Details

I. General information

NPI: 1497902357
Provider Name (Legal Business Name): VICTORIA MATTOX NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2008
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 4TH ST BAY 3
SAN FRANCISCO CA
94143-2351
US

IV. Provider business mailing address

23401 E PORTLAND WAY
AURORA CO
80016-2411
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-1565
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number26NJ00908000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number0024173324
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number95004441
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: