Basic Information
| Provider Information | |||||||||
| NPI: | 1245204239 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHUFFELTON | ||||||||
| FirstName: | VICTORIA | ||||||||
| MiddleName: | G. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | FILE# 54433 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900740001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8587845906 | ||||||||
| FaxNumber: | 8587845933 | ||||||||
| Practice Location | |||||||||
| Address1: | 10862 CALLE VERDE | ||||||||
| Address2: | |||||||||
| City: | LA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919417338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6196705400 | ||||||||
| FaxNumber: | 8587845933 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2006 | ||||||||
| LastUpdateDate: | 02/22/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 20A8770 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.