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General NPI Number Information
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NPI Number | 1154002855
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Entity Type | Organization
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Legal Business Name | VICTORIOUS HEALTH LLC
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Dates
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Enumeration Date | 07/26/2023
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Last Update Date | 01/22/2026
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Provider Practice Location Address
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Address Line | 10400 GRIFFIN RD STE 107
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City | DAVIE
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State | FL
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Zip | 33328-3320
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Country | US
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Telephone | 786-697-0703
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Fax |
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Provider Business Mailing Address
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Address Line | 5965 STIRLING RD PMB 391
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City | DAVIE
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State | FL
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Zip | 33314-7225
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Country | US
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Telephone | 786-697-0703
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | ISABELO IAN DOMINGO VICTORIO
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Credential | NP
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Telephone | 786-697-0703
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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