Provider Demographics
NPI:1912515305
Name:VICTORY HEALTH SOLUTION LLC
Entity type:Organization
Organization Name:VICTORY HEALTH SOLUTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IBUKUN
Authorized Official - Middle Name:O
Authorized Official - Last Name:ODUTOLA
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC DNP
Authorized Official - Phone:602-502-4872
Mailing Address - Street 1:1136 E HARMONY AVE # 202B-2
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-5844
Mailing Address - Country:US
Mailing Address - Phone:602-502-4872
Mailing Address - Fax:480-210-3563
Practice Address - Street 1:1136 E HARMONY AVE # 202B-2
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5844
Practice Address - Country:US
Practice Address - Phone:602-502-4872
Practice Address - Fax:480-210-3563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-21
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty