Provider Demographics
NPI:1992537302
Name:ADMIRE, VICTORIA SECRET
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:SECRET
Last Name:ADMIRE
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 1:928 RUTLEDGE DR
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-2142
Mailing Address - Country:US
Mailing Address - Phone:209-371-1890
Mailing Address - Fax:
Practice Address - Street 1:1111 W TOKAY ST
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-3965
Practice Address - Country:US
Practice Address - Phone:209-330-7155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker