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General NPI Number Information
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NPI Number | 1720132012
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Entity Type | Individual
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Provider Name | VICTORIA LOMAX SPECIAN PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 12/26/2014
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Provider Practice Location Address
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Address Line | 1625 DAVID RAINES RD
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City | SHREVEPORT
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State | LA
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Zip | 71107-5899
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Country | US
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Telephone | 318-227-3348
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Fax | 318-425-2367
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Provider Business Mailing Address
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Address Line | 1625 DAVID RAINES RD
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City | SHREVEPORT
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State | LA
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Zip | 71107-5899
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Country | US
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Telephone | 318-227-3348
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Fax | 318-425-2367
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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 | 101Y00000X
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Taxonomy Name | Counselor
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA06497
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.200299
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License Number State | LA
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