Provider Demographics
NPI:1114396819
Name:KLEBAN, VICTORIA J
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:J
Last Name:KLEBAN
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 1:2180 W. VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:POMON
Mailing Address - State:CA
Mailing Address - Zip Code:91768
Mailing Address - Country:US
Mailing Address - Phone:909-865-2336
Mailing Address - Fax:909-865-1831
Practice Address - Street 1:2180 VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91768-3325
Practice Address - Country:US
Practice Address - Phone:909-865-2336
Practice Address - Fax:909-865-1831
Is Sole Proprietor?:No
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)