Basic Information
| Provider Information | |||||||||
| NPI: | 1447463500 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VICTORIA | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2701 N TENAYA WAY STE 190 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891281405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024633008 | ||||||||
| FaxNumber: | 7023042147 | ||||||||
| Practice Location | |||||||||
| Address1: | 7391 W CHARLESTON BLVD | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891171577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023042144 | ||||||||
| FaxNumber: | 7023042147 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2007 | ||||||||
| LastUpdateDate: | 08/12/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 12452 | NV | N | Allopathic & Osteopathic Physicians | Hospitalist | 207Q00000X | 12452 | NV | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.