MEDICARE: VICTORIA CIMO DPT

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	PT303031	CA

General Provider Information

NPI Number	:	1871374538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA CIMO DPT

Provider Business Mailing Address
First Line	:	5440 MOREHOUSE DR STE 2900
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-6704
Country	:	US
Telephone Number	:	858-457-8419
Fax Number	:	858-457-0670

Provider Business Practice Location Address
First Line	:	5440 MOREHOUSE DR STE 2900
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-6704
Country	:	US
Telephone Number	:	858-457-8419
Fax Number	:	858-457-0670

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

Provider Enumeration Date	:	10/09/2023
Last Update Date	:	10/09/2023

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Directions to “ VICTORIA CIMO DPT” Practice Location

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