Healthcare Provider Details

I. General information

NPI: 1679911796
Provider Name (Legal Business Name): VICTORIA HEMATOLOGY & ONCOLOGY ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2013
Last Update Date: 11/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 HOSPITAL DR SUITE 401
VICTORIA TX
77901-5775
US

IV. Provider business mailing address

2705 HOSPITAL DR SUITE 401
VICTORIA TX
77901-5775
US

V. Phone/Fax

Practice location:
  • Phone: 361-582-7949
  • Fax: 361-582-7945
Mailing address:
  • Phone: 361-582-7949
  • Fax: 361-582-7945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. FARIBORZ GOROUHI
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 305-898-6800