Provider Demographics
NPI:1043305618
Name:STRELZOW, VICTOR VITALY (MD)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:VITALY
Last Name:STRELZOW
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:16300 SAND CANYON AVE
Mailing Address - Street 2:SUITE 704
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618
Mailing Address - Country:US
Mailing Address - Phone:949-753-9299
Mailing Address - Fax:949-753-7417
Practice Address - Street 1:16300 SAND CANYON AVE
Practice Address - Street 2:SUITE 704
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618
Practice Address - Country:US
Practice Address - Phone:949-753-9299
Practice Address - Fax:949-753-7417
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA32942207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA26983Medicare UPIN