MEDICARE: VICTORY ALLIANCE LLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1790158475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICTORY ALLIANCE LLC

Provider Business Mailing Address
First Line	:	222 S RAINBOW BLVD STE 107
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-5343
Country	:	US
Telephone Number	:	702-912-5404
Fax Number	:	702-786-6911

Provider Business Practice Location Address
First Line	:	222 S RAINBOW BLVD STE 107
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-5343
Country	:	US
Telephone Number	:	702-912-5404
Fax Number	:	702-786-6911

Authorized Official
Title or Position	:	OWNER
Name	:	ALEXANDRA LAPLANTE
Credential	:
Telephone Number	:	702-378-6092

Provider Enumeration Date	:	11/04/2015
Last Update Date	:	07/29/2021

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Directions to “VICTORY ALLIANCE LLC ” Practice Location

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