Provider Demographics
NPI:1073291522
Name:DELA VICTORIA, ANGELIQUE MERCEDES (OD)
Entity type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:MERCEDES
Last Name:DELA VICTORIA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5094 MASOTTA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-3887
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2870 S MARYLAND PKWY STE 300
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-1552
Practice Address - Country:US
Practice Address - Phone:027-242-0207
Practice Address - Fax:702-724-2800
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1179152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist