Basic Information
| Provider Information | |||||||||
| NPI: | 1093102964 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VICTORIA | ||||||||
| FirstName: | RODOLFO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3642 E 61ST PL | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON PK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902553231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3238106840 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 WILSHIRE BLVD | ||||||||
| Address2: | #240 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900172457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4242011600 | ||||||||
| FaxNumber: | 4242011601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2015 | ||||||||
| LastUpdateDate: | 04/18/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC1900X | 27039 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Counseling |
No ID Information.