Gustavo Victoria, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA55687 Issued in CA

Practice address

2801 S San Pedro St
Los Angeles, CA 90011-2023

Phone

(323) 233-3100

Fax

(323) 233-3124

NPI assigned

Jun 22, 2018

Last updated

Jan 7, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Complete Care Community Health Center, Inc

  • PACE Provider Organization
  • Los Angeles, CA
  • NPI 1215113964
  Medicare reassignment NPD
• Healthcare Partners Affiliates Medical Group

  dba Optum

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1659312593
  Medicare reassignment NPD
• Complete Care Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Visalia, CA
  • NPI 1316729403
  NPD
• Healthcare Partners Affiliates Medical Group

  dba Optum

  • Durable Medical Equipment & Medical Supplies
  • Murrieta, CA
  • NPI 1760057269
  NPD

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

{
    "created_epoch": "1529625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546819200000",
    "number": "1962997973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14924 S CASTLEGATE AVE",
            "city": "EAST RANCHO DOMINGUEZ",
            "state": "CA",
            "postal_code": "902213024",
            "telephone_number": "310-722-3519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 S SAN PEDRO ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900112023",
            "telephone_number": "323-233-3100",
            "fax_number": "323-233-3124"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1005 E Washington Blvd Ste A",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900213082",
            "country_code": "US",
            "telephone_number": "323-233-3100 x310",
            "fax_number": "323-233-3124",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VICTORIA",
        "first_name": "GUSTAVO",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-06-22",
        "last_updated": "2019-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "55687",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA55687",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victoria a Menchaca PHD a Psychological Corporation
• Victoria Home Health Nursing Agency, Inc.
• Victoria Lucas Professional Chiropractic Corporation
• Victoria Nellie Afriyie (Four-Point Medical Equipment & Supp)
• Esmeralda Victoria
• Nikolas Christopher Victoria, MD
• Rodolfo Victoria, PH.D.
• Fidji Victoriano
• Leticia Ann Victorino, A.C.S.W.
• Francis Angelo Victorio

• Physician Assistant in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.