Provider Demographics
NPI:1588718902
Name:WOODEN, VICTORIA LLANES (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LLANES
Last Name:WOODEN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4459 PHILBROOK SQ
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-8674
Mailing Address - Country:US
Mailing Address - Phone:858-481-5323
Mailing Address - Fax:858-481-1343
Practice Address - Street 1:4459 PHILBROOK SQ
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-8674
Practice Address - Country:US
Practice Address - Phone:858-481-5323
Practice Address - Fax:858-481-1343
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA11506363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18541Medicare ID - Type UnspecifiedMEDICARE