Provider Demographics
NPI:1104351097
Name:KRAFFT, VICTORIA S (PA)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:S
Last Name:KRAFFT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:801 E KATELLA AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-6614
Mailing Address - Country:US
Mailing Address - Phone:714-633-6373
Mailing Address - Fax:
Practice Address - Street 1:15403 PARK AVE E
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-2482
Practice Address - Country:US
Practice Address - Phone:909-890-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-27
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
CA54861207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant