Healthcare Provider Details

I. General information

NPI: 1881709780
Provider Name (Legal Business Name): VICTORIA ANESTHESIOLOGY ASSOC LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 E MOCKINGBIRD LN SUITE 101
VICTORIA TX
77904-2155
US

IV. Provider business mailing address

PO BOX 4897
HOUSTON TX
77210-4897
US

V. Phone/Fax

Practice location:
  • Phone: 361-573-6291
  • Fax: 361-576-2434
Mailing address:
  • Phone: 361-573-6291
  • Fax: 361-576-2434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: BUDDY R NIELSEN
Title or Position: MD
Credential: MD
Phone: 361-573-2481