Healthcare Provider Details

I. General information

NPI: 1124114467
Provider Name (Legal Business Name): VICTORIA ELECTROCARDIOGRAPHY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 11/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1908 N LAURENT ST SUITE 550
VICTORIA TX
77901-5468
US

IV. Provider business mailing address

1908 N LAURENT ST SUITE 550
VICTORIA TX
77901-5468
US

V. Phone/Fax

Practice location:
  • Phone: 361-572-0333
  • Fax: 361-572-0104
Mailing address:
  • Phone: 361-572-0333
  • Fax: 361-572-0104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES GRUMMAN
Title or Position: DIRECTOR
Credential: MD
Phone: 361-572-0333