Provider Demographics
NPI:1023206299
Name:BARRERA, VICTORIA L (HHP, MS)
Entity Type:Individual
Prefix:MISS
First Name:VICTORIA
Middle Name:L
Last Name:BARRERA
Suffix:
Gender:F
Credentials:HHP, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 LAUREL ST STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-1473
Mailing Address - Country:US
Mailing Address - Phone:619-723-3960
Mailing Address - Fax:858-731-9695
Practice Address - Street 1:239 LAUREL ST
Practice Address - Street 2:STE 102
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-1472
Practice Address - Country:US
Practice Address - Phone:619-723-3960
Practice Address - Fax:858-731-9695
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33998174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist