MEDICARE: VICTORIA NELLIE AFRIYIE

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	332B00000X	Durable Medical Equipment & Medical Supplies	103746	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679580765
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICTORIA NELLIE AFRIYIE

Provider Business Mailing Address
First Line	:	3756 SANTA ROSALIA DR
Second Line	:	STE 225
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-3616
Country	:	US
Telephone Number	:	323-299-1338
Fax Number	:	323-299-1331

Provider Business Practice Location Address
First Line	:	3756 SANTA ROSALIA DR
Second Line	:	STE 225
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-3616
Country	:	US
Telephone Number	:	323-299-1338
Fax Number	:	323-299-1331

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. VICTORIA NELLIE AFRIYIE
Credential	:
Telephone Number	:	323-299-1338

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	07/01/2008

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Directions to “VICTORIA NELLIE AFRIYIE ” Practice Location

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