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General NPI Number Information
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NPI Number | 1073291522
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Entity Type | Individual
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Provider Name | ANGELIQUE MERCEDES DELA VICTORIA OD
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Gender | Female
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Dates
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Enumeration Date | 07/06/2023
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Last Update Date | 09/20/2024
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Provider Practice Location Address
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Address Line | 2870 S MARYLAND PKWY STE 300
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City | LAS VEGAS
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State | NV
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Zip | 89109-1552
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Country | US
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Telephone | 27-242-0207
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Fax | 702-724-2800
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Provider Business Mailing Address
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Address Line | 5094 MASOTTA AVE
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City | LAS VEGAS
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State | NV
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Zip | 89141-3887
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1179
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License Number State | NV
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