Provider Demographics
NPI:1548360555
Name:JOGA, VIKTORIJA A (DC)
Entity type:Individual
Prefix:DR
First Name:VIKTORIJA
Middle Name:A
Last Name:JOGA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 S GERTRUDA AVE
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-4243
Mailing Address - Country:US
Mailing Address - Phone:104-333-6573
Mailing Address - Fax:310-828-3532
Practice Address - Street 1:13101 W WASHINGTON BLVD STE 114
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-5176
Practice Address - Country:US
Practice Address - Phone:104-333-6573
Practice Address - Fax:310-828-3532
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20733111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU115296Medicare UPIN
CADC20733Medicare ID - Type UnspecifiedMEDICARE ID