Provider Demographics
NPI:1033223037
Name:CONTRERAS, VICTOR D (MD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:D
Last Name:CONTRERAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-2803
Mailing Address - Country:US
Mailing Address - Phone:905-525-4446
Mailing Address - Fax:805-525-7211
Practice Address - Street 1:126 N 10TH ST
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-2803
Practice Address - Country:US
Practice Address - Phone:905-525-4446
Practice Address - Fax:805-525-7211
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG52723207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA52329Medicare UPIN