Individual
MRS. VICTORIA PHAM RANDAZZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD, AG-NP, RN
Contact information
Practice address
13522 NEWPORT AVE STE 102, TUSTIN, CA 92780-3707
(714) 573-8200
(714) 573-9401
Mailing address
7745 E WALNUT RIDGE RD, ORANGE, CA 92869-6515
(714) 743-9494
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
95012573
CA
363LG0600X
Gerontology Nurse Practitioner
Primary
95012573
CA
363LP2300X
Primary Care Nurse Practitioner
95012573
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
95012573
NURSE PRACTITIONER FURNISHING LICENSE
CA
Enumeration date
09/10/2019
Last updated
09/10/2019
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