MEDICARE: VICTORIA FOGG RN

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	163W00000X	Registered Nurse	RN710239	CA

General Provider Information

NPI Number	:	1942735188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA FOGG RN

Provider Business Mailing Address
First Line	:	6209 MESITA DR REAR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-2526
Country	:	US
Telephone Number	:	619-339-7626
Fax Number	:

Provider Business Practice Location Address
First Line	:	6209 MESITA DR REAR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-2526
Country	:	US
Telephone Number	:	619-223-4001
Fax Number	:

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

Provider Enumeration Date	:	04/25/2017
Last Update Date	:	04/25/2017

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