| Victorian Care Medical Group, Inc. | |
|
11149 Crenshaw Blvd Inglewood CA 90303-2338 | |
| (310) 677-4600 | |
| (310) 677-4600 |
| Full Name | Victorian Care Medical Group, Inc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 11149 Crenshaw Blvd, Inglewood, California |
| Authorized Official Name and Position | Nwachukwu A. Anakwenze (OWNER/DOCTOR) |
| Authorized Official Contact | 3106774600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Victorian Care Medical Group, Inc. Po Box 88939 Los Angeles CA 90009-6939 Ph: (310) 677-4600 | Victorian Care Medical Group, Inc. 11149 Crenshaw Blvd Inglewood CA 90303-2338 Ph: (310) 677-4600 |
| NPI Number | 1821172008 |
|---|---|
| Provider Enumeration Date | 10/25/2006 |
| Last Update Date | 11/09/2017 |
| Medicare PECOS PAC ID | 7911810197 |
|---|---|
| Medicare Enrollment ID | O20031112000672 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821172008 | NPI | - | NPPES |
| 00G506070 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | W9384 (California) | Primary |
| 225100000X | Physical Therapist | (* (Not Available)) | Secondary |
| Provider Name | Nwachukwu A Anakwenze |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1255417309 PECOS PAC ID: 5193639383 Enrollment ID: I20111101000236 |
| Provider Name | Vicki M Anakwenze |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1992986947 PECOS PAC ID: 0941475255 Enrollment ID: I20111215000501 |
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