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MR. GUSTAVO VICTORIA PA
NPI 1962997973
Physician Assistant in Los Angeles, CA

Active since June 22, 2018PECOS Enrolled
2801 S SAN PEDRO ST, LOS ANGELES, CA 90011(323) 233-3100(323) 233-3124 Get Directions Write a Review

NPPES record last updated: January 7, 2019. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jan 7, 2019, Jun 22, 2018 (2 updates tracked since 2018).

About Mr. Gustavo Victoria Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. GUSTAVO VICTORIA PA (NPI 1962997973) is an individual physician assistant in Los Angeles, California, licensed in California (PA55687) and active in the NPI registry since June 2018. He is enrolled in Medicare PECOS and maintains a secondary practice location in Los Angeles.

NPPES Registry Identity

NPI1962997973
Entity TypeIndividualMale
Primary Taxonomy363A00000X
Provider Legal NameMR. GUSTAVO VICTORIACredential: PA
Location Address2801 S SAN PEDRO STLos Angeles, CA 90011-2023
Mailing Address14924 S Castlegate AveEast Rancho Dominguez, CA 90221-3024 · (310) 722-3519
Phone(323) 233-3100
Fax(323) 233-3124
Sole ProprietorYes
Enumeration DateJune 22, 2018
Last NPPES UpdateJanuary 7, 20192 updates tracked since enumeration
✔ NPI 1962997973 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
Licenses✔ Licensed in CA · PA55687✔ Licensed in CA · 55687
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
2801 S SAN PEDRO ST, Los Angeles, CA 90011
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Secondary Practice Location 1

Location 11005 E Washington Blvd Ste ALos Angeles, CA 90021-3082 · Phone (323) 233-3100 ext. 310 · Fax (323) 233-3124

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mr. Gustavo Victoria Pa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 90011 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$96.36 typical visit price
range $62.96 – $187.60
Typical copayment $24.09 (range $15.74 – $46.90)
Most-billed visit code 99203
Established Patient
$77.96 typical visit price
range $20.84 – $153.61
Typical copayment $19.49 (range $5.21 – $38.40)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 13

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. JONATHAN OLUMOYA M.D.
Family Medicine
2801 S SAN PEDRO ST
LOS ANGELES, CA 90011
Los Angeles County (323) 233-3100
BLANCA ALLEN NP
Nurse Practitioner (Family)
2801 S SAN PEDRO ST
LOS ANGELES, CA 90011
Los Angeles County (323) 233-3100
UNIVERSAL COMMUNITY HEALTH CENTER
Clinic/Center (Federally Qualified Health Center (FQHC))
2801 S SAN PEDRO ST
LOS ANGELES, CA 90011
Los Angeles County (323) 233-3100
UNIVERSAL COMMUNITY HEALTH CENTER
Clinic/Center (Federally Qualified Health Center (FQHC))
2801 S SAN PEDRO ST
LOS ANGELES, CA 90011
Los Angeles County (323) 233-3100
EMILY LARA
Physician Assistant
2801 S SAN PEDRO ST
LOS ANGELES, CA 90011
Los Angeles County (323) 233-3100
SERGIO CHAVEZ
Physician Assistant
2801 S SAN PEDRO ST
LOS ANGELES, CA 90011
Los Angeles County (323) 233-3100
TERESA SANCHEZ PA
Physician Assistant
2801 S SAN PEDRO ST
LOS ANGELES, CA 90011
Los Angeles County (323) 233-3400
ISABELLE MAI PAMART-TRAN
Physician Assistant (Medical)
2801 S SAN PEDRO ST
LOS ANGELES, CA 90011
Los Angeles County (323) 233-3100

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Gustavo Victoria's NPI number?

The NPI number for Gustavo Victoria is 1962997973. It was assigned to this individual provider in the NPPES registry on June 22, 2018.

Where is Gustavo Victoria located?

Gustavo Victoria practices at 2801 S San Pedro St, Los Angeles, CA 90011. The listed phone number is (323) 233-3100.

What is Gustavo Victoria's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Gustavo Victoria enrolled in Medicare?

Yes. Gustavo Victoria is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Gustavo Victoria was last updated on January 7, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.