Individual provider Active NPI

Victoria M. Mirza, M.D.

  • Internal Medicine Physician
  • Encinitas, CA
National Provider Identifier
1104914894
Registry record updated Jun 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A87119 Issued in CA
Practice address
354 Santa Fe Dr
Encinitas, CA 92024
Phone
(760) 230-2251
Fax
(760) 230-2253
NPI assigned
Oct 10, 2006
Last updated
Jun 1, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A87119 CA Primary

Addresses

Primary practice location

354 Santa Fe Dr
Encinitas, CA 92024

Mailing address

PO Box 231189
Encinitas, CA 92023-1189
Phone (760) 230-2251

Other identifiers 1

IdentifierTypeStateIssuer
02601783MedicaidNY

Other names 1

  • Victoria M Ettinger 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
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
87119CAMDPharmacist
A87119CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Scripps Health Current Accepting new patients
Encinitas Palliative Care Associates, Inc. Internal Medicine Past Accepting new patients
Enlightened Healthcare Alliance Medical Corporation Internal Medicine PastSince Oct 8, 2022 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: vmirza28488@scrippshlth.medalliesdirect.net

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527811200000",
    "number": "1104914894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 231189",
            "city": "ENCINITAS",
            "state": "CA",
            "postal_code": "920231189",
            "telephone_number": "760-230-2251",
            "fax_number": "760-230-2253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "354 SANTA FE DR",
            "city": "ENCINITAS",
            "state": "CA",
            "postal_code": "92024",
            "telephone_number": "760-230-2251",
            "fax_number": "760-230-2253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRZA",
        "first_name": "VICTORIA",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-10",
        "last_updated": "2018-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A87119",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02601783",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "VICTORIA",
            "last_name": "ETTINGER",
            "middle_name": "M",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Encinitas, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2018; 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.