Provider Demographics
NPI:1285059352
Name:DODGE, VICTORIA (SFIDC)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:DODGE
Suffix:
Gender:F
Credentials:SFIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 E FLOWER ST APT 76
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-7610
Mailing Address - Country:US
Mailing Address - Phone:602-376-6590
Mailing Address - Fax:
Practice Address - Street 1:50 E FLOWER ST APT 76
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-7610
Practice Address - Country:US
Practice Address - Phone:602-376-6590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman