Individual provider Active NPI

Victoria S. Krafft, PA

  • Family Medicine Physician
  • Victorville, CA
National Provider Identifier
1104351097
Registry record updated Nov 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
54861 Issued in CA
Practice address
15403 Park Ave E
Victorville, CA 92392-2482
Phone
(909) 890-5511
NPI assigned
Apr 27, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Family Medicine Physician 207Q00000X 54861 CA Primary

Addresses

Primary practice location

15403 Park Ave E
Victorville, CA 92392-2482

Mailing address

801 E Katella Ave
Anaheim, CA 92805-6614
Phone (714) 633-6373

Other names 1

  • Victoria Brown Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
54861CAMDDentist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1493251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637193600000",
    "number": "1104351097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 E KATELLA AVE",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928056614",
            "telephone_number": "714-633-6373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15403 PARK AVE E",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923922482",
            "telephone_number": "909-890-5511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRAFFT",
        "first_name": "VICTORIA",
        "middle_name": "S.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-27",
        "last_updated": "2021-11-18",
        "certification_date": "2021-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "54861",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "VICTORIA",
            "last_name": "BROWN",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Victorville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.