Provider Demographics
NPI:1013194976
Name:JACOB, VICTORIA ILAH (LVN)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ILAH
Last Name:JACOB
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:CA
Mailing Address - Zip Code:93215-2238
Mailing Address - Country:US
Mailing Address - Phone:661-721-0463
Mailing Address - Fax:661-721-0482
Practice Address - Street 1:1019 JEFFERSON STREET
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215
Practice Address - Country:US
Practice Address - Phone:661-721-0463
Practice Address - Fax:661-721-0482
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN171173164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse