Individual
MR. KIRK LANCE VICTORIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2415 E. VANDELL DR, SUIT B, EL PASO, TX 79903-3616
(915) 577-0111
(915) 533-2568
Mailing address
PO BOX 3899, EL PASO, TX 79923-3899
(915) 577-0030
(915) 533-2568
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
718442
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
AP115614
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
185664301
—
TX
01
—
87234U
BCBS
TX
Enumeration date
03/22/2007
Last updated
11/04/2019
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