Individual
MR. GUSTAVO VICTORIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2801 S SAN PEDRO ST, LOS ANGELES, CA 90011-2023
(323) 233-3100
(323) 233-3124
Mailing address
14924 S CASTLEGATE AVE, EAST RANCHO DOMINGUEZ, CA 90221-3024
(310) 722-3519
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
55687
CA
363A00000X
Physician Assistant
Primary
PA55687
CA
Other
Enumeration date
06/22/2018
Last updated
01/07/2019
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