Provider Demographics
NPI:1023222528
Name:VO, VICTORIA DIEM
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:DIEM
Last Name:VO
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 1:13125 VIA CANYON DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2255
Mailing Address - Country:US
Mailing Address - Phone:858-240-7482
Mailing Address - Fax:
Practice Address - Street 1:8985 MIRA MESA BOULAVARD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-6040
Practice Address - Country:US
Practice Address - Phone:858-566-3490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56678183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist