MEDICARE: VICTORIAN CARE MEDICAL GROUP, INC.

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	225100000X	Physical Therapist
2	207R00000X	Internal Medicine Physician	W9384	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	:	1821172008
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICTORIAN CARE MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	PO BOX 88939
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90009-6939
Country	:	US
Telephone Number	:	310-677-4600
Fax Number	:	310-914-9705

Provider Business Practice Location Address
First Line	:	11149 CRENSHAW BLVD
Second Line	:
City	:	INGLEWOOD
State	:	CA
Zip	:	90303-2338
Country	:	US
Telephone Number	:	310-677-4600
Fax Number	:	310-677-4600

Authorized Official
Title or Position	:	OWNER/DOCTOR
Name	:	NWACHUKWU A. ANAKWENZE
Credential	:	MD
Telephone Number	:	310-677-4600

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	11/09/2017

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