Provider Demographics
NPI:1053203612
Name:BOURDON, VICTORIA CELESTE
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:CELESTE
Last Name:BOURDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8025 RAINBOW CANYON RD APT E
Mailing Address - Street 2:
Mailing Address - City:TWENTYNINE PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92277-5569
Mailing Address - Country:US
Mailing Address - Phone:210-548-0745
Mailing Address - Fax:
Practice Address - Street 1:7248 JOSHUA LN
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-2923
Practice Address - Country:US
Practice Address - Phone:760-365-7130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker