Provider Demographics
NPI:1447671565
Name:VICTORIANO, GEORGE ROBERT I III (CRNA)
Entity type:Individual
Prefix:MR
First Name:GEORGE ROBERT
Middle Name:I
Last Name:VICTORIANO
Suffix:III
Gender:M
Credentials:CRNA
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:1332 N LINDA VISTA CT
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-3287
Mailing Address - Country:US
Mailing Address - Phone:956-867-1655
Mailing Address - Fax:
Practice Address - Street 1:115 MALL DR
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-5786
Practice Address - Country:US
Practice Address - Phone:956-867-1655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-16
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101380367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered