Healthcare Provider Details

I. General information

NPI: 1962385922
Provider Name (Legal Business Name): VICTORY LIFE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PALOMA BLANCA DR
CHAPARRAL NM
88081-7949
US

IV. Provider business mailing address

300 PALOMA BLANCA DR
CHAPARRAL NM
88081-7949
US

V. Phone/Fax

Practice location:
  • Phone: 575-251-3801
  • Fax:
Mailing address:
  • Phone: 575-251-3801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY CONTRERAS
Title or Position: CHIEF TECHNOLOGY OFFICER
Credential:
Phone: 915-929-3534