MEDICARE: VICTORIA MATTOX NP

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	363LN0005X	Critical Care Neonatal Nurse Practitioner	26NJ00908000	NJ
2	363LN0005X	Critical Care Neonatal Nurse Practitioner	0024173324	VA
3	363LN0005X	Critical Care Neonatal Nurse Practitioner	95004441	CA

General Provider Information

NPI Number	:	1497902357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA MATTOX NP

Provider Business Mailing Address
First Line	:	23401 E PORTLAND WAY
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80016-2411
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1975 4TH ST BAY 3
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94143-2351
Country	:	US
Telephone Number	:	415-353-1565
Fax Number	:

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

Provider Enumeration Date	:	08/22/2008
Last Update Date	:	12/05/2025

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