Individual provider Active NPI

Allain Julian Camanag Victoriano, RN, PHN, AGPCNP-BC

  • Primary Care Nurse Practitioner
  • Downey, CA
National Provider Identifier
1558807024
Registry record updated Aug 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
95026004 Issued in CA
Practice address
10000 Lakewood Blvd
Downey, CA 90240-4020
Phone
(562) 862-3684
NPI assigned
Jan 9, 2017
Last updated
Aug 19, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X 95026004 CA Primary
Student in an Organized Health Care Education/Training Program 390200000X CA
General Practice Registered Nurse 163WG0000X 95173882 CA

Addresses

Primary practice location

10000 Lakewood Blvd
Downey, CA 90240-4020

Mailing address

15723 Thornlake Ave
Norwalk, CA 90650-6768
Phone (562) 275-5860

Other practice location 1

9862 Chapman Ave Ste B
Garden Grove, CA 92841-2726
Phone (714) 620-7001

Other practice location 2

456 Elm Ave
Long Beach, CA 90802-2426
Phone (562) 437-6717

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240924002929 CA Practitioner - Nurse Practitioner 5395286868 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
95173882CAMDGeneral Practice Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Albion Medical Partners of California West P C CurrentSince Sep 1, 2024 Accepting new patients

Locations

12900 Park Plaza Dr
Ste 700
Cerritos, CA 90703
Phone (562) 622-2800

Interoperability endpoints

  • Direct secure messaging: allain.julian.victoriano.1@32527.direct.athenahealth.com
  • Direct secure messaging: allanijulian.victoriano.p1@direct.caremorewest.nextgenshare.com

Organizations & group practices 1

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": "1483920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724025600000",
    "number": "1558807024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15723 THORNLAKE AVE",
            "city": "NORWALK",
            "state": "CA",
            "postal_code": "906506768",
            "telephone_number": "562-275-5860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10000 LAKEWOOD BLVD",
            "city": "DOWNEY",
            "state": "CA",
            "postal_code": "902404020",
            "telephone_number": "562-862-3684"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9862 Chapman Ave Ste B",
            "address_purpose": "LOCATION",
            "city": "Garden Grove",
            "state": "CA",
            "postal_code": "928412726",
            "country_code": "US",
            "telephone_number": "714-620-7001",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "456 Elm Ave",
            "address_purpose": "LOCATION",
            "city": "Long Beach",
            "state": "CA",
            "postal_code": "908022426",
            "country_code": "US",
            "telephone_number": "562-437-6717",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VICTORIANO",
        "first_name": "ALLAIN JULIAN",
        "middle_name": "CAMANAG",
        "credential": "RN, PHN, AGPCNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-01-09",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "CA",
            "license": "95026004",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "CA",
            "license": "95173882",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Downey, CA

Sources for this page

Verify at the official NPI Registry.