MEDICARE: VICTORIA LARIOS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1710I1002X	Independent Duty Corpsman

General Provider Information

NPI Number	:	1124799242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA LARIOS

Provider Business Mailing Address
First Line	:	6767 N BASIN AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97217-3929
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1050 REGISTER ST
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-2421
Country	:	US
Telephone Number	:	843-529-0158
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2021
Last Update Date	:	07/30/2024

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Directions to “ VICTORIA LARIOS ” Practice Location

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