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General NPI Number Information
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NPI Number | 1992031132
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Entity Type | Organization
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Legal Business Name | VICTORY CARE INC
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Dates
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Enumeration Date | 10/22/2009
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Last Update Date | 10/22/2009
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Provider Practice Location Address
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Address Line | 2131 ELKS DR STE 103
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City | SAN BERNARDINO
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State | CA
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Zip | 92404-5571
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Country | US
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Telephone | 909-253-2326
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Fax |
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Provider Business Mailing Address
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Address Line | 501 W GLENOAKS BLVD STE 809
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City | GLENDALE
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State | CA
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Zip | 91202-2896
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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 | PRESIDENT
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Name | GREGORY REIBER
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Credential |
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Telephone | 909-253-2326
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZC0006X
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Taxonomy Name | Clinical Pathology Physician
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License Number | G48802
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License Number State | CA
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