Provider Demographics
NPI:1194150383
Name:NDUBAKU, VICTORIA
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:NDUBAKU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6769 VERDE RIDGE RD
Mailing Address - Street 2:700
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-4648
Mailing Address - Country:US
Mailing Address - Phone:310-702-7144
Mailing Address - Fax:310-280-9675
Practice Address - Street 1:9808 VENICE BLVD
Practice Address - Street 2:700
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2732
Practice Address - Country:US
Practice Address - Phone:310-945-3350
Practice Address - Fax:310-945-3356
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-06
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP20447363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health