MEDICARE: VICTORY FIRST ASSISTANTS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	211D00000X	Podiatric Assistant
2	363AS0400X	Surgical Physician Assistant
3	163WS0121X	Plastic Surgery Registered Nurse
4	163WR0006X	Registered Nurse First Assistant

General Provider Information

NPI Number	:	1104285279
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICTORY FIRST ASSISTANTS, LLC

Provider Business Mailing Address
First Line	:	412 ROUNDROCK LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76140-6547
Country	:	US
Telephone Number	:	817-886-3466
Fax Number	:

Provider Business Practice Location Address
First Line	:	412 ROUNDROCK LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76140-6547
Country	:	US
Telephone Number	:	817-886-3466
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	VICTORIANO PARILLA
Credential	:	BSN, RN, CNOR, RNFA
Telephone Number	:	817-682-3792

Provider Enumeration Date	:	02/18/2016
Last Update Date	:	02/18/2016

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Directions to “VICTORY FIRST ASSISTANTS, LLC ” Practice Location

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