Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 32334 | CO |
NPI | 1558374926 |
---|---|
Provider Name | Dr. Victoria Van Beuren King |
First Address | Penrose, CO 81240-9551 |
Second Address | Canon City, CO 81212-8114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2006 |
Last Update Date | 16/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01323344 | (05) | CO |