MEDICARE: EDWARD S. VICTORIA, PLLC

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	207Q00000X	Family Medicine Physician	12452	NV

General Provider Information

NPI Number	:	1750784583
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDWARD S. VICTORIA, PLLC

Provider Business Mailing Address
First Line	:	2701 N TENAYA WAY STE 190
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-1405
Country	:	US
Telephone Number	:	702-463-3008
Fax Number	:	702-463-3051

Provider Business Practice Location Address
First Line	:	2701 N TENAYA WAY
Second Line	:	SUITE 230
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0478
Country	:	US
Telephone Number	:	702-463-3008
Fax Number	:	702-463-3051

Authorized Official
Title or Position	:	OWNER
Name	:	DR. EDWARD S VICTORIA
Credential	:	M.D.
Telephone Number	:	702-463-3008

Provider Enumeration Date	:	10/07/2014
Last Update Date	:	03/10/2025

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