Individual
GERARD M. VICTORIANO JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
524 DR MICHAEL DEBAKEY DR, LAKE CHARLES, LA 70601-5725
(337) 491-7709
(337) 491-7157
Mailing address
14050 NW 14TH ST, SUITE 190, SUNRISE, FL 33323-2865
(800) 424-3672
(954) 377-3042
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.200317
LA
Other
Enumeration date
10/07/2009
Last updated
10/07/2009
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