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General NPI Number Information
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NPI Number | 1184777922
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Entity Type | Organization
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Legal Business Name | CLINICA LA VICTORIA A MEDICAL CORPORATION
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 02/13/2019
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Provider Practice Location Address
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Address Line | 2303 S UNION AVE SUITE C2
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City | BAKERSFIELD
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State | CA
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Zip | 93307-4677
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Country | US
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Telephone | 661-885-7007
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Fax | 661-735-3699
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Provider Business Mailing Address
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Address Line | 2303 S UNION AVE SUITE C2
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City | BAKERSFIELD
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State | CA
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Zip | 93307-4677
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Country | US
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Telephone | 661-885-7007
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Fax | 661-735-3699
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Authorized Official
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Title or Position | PROVIDER
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Name | JUAN CORONA
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Credential | P.A.C.
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Telephone | 661-885-7007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A61306
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State | CA
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