Provider Demographics
NPI:1699786491
Name:VICTORIA, MARIA NIMFA RAYMUNDO (DMD)
Entity type:Individual
Prefix:DR
First Name:MARIA NIMFA
Middle Name:RAYMUNDO
Last Name:VICTORIA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1559 E AMAR RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-1679
Mailing Address - Country:US
Mailing Address - Phone:626-964-7599
Mailing Address - Fax:626-912-3410
Practice Address - Street 1:1559 E AMAR RD
Practice Address - Street 2:SUITE G
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-1679
Practice Address - Country:US
Practice Address - Phone:626-964-7599
Practice Address - Fax:626-912-3410
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA424421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB42442-01OtherDENTICAL PROVIDER NUMBER