Provider Demographics
NPI:1184816688
Name:SANVICTORES, JAY I (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:I
Last Name:SANVICTORES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:11420 WARNER AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-2529
Mailing Address - Country:US
Mailing Address - Phone:714-549-1300
Mailing Address - Fax:714-433-3100
Practice Address - Street 1:11420 WARNER AVE
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-2529
Practice Address - Country:US
Practice Address - Phone:714-549-1300
Practice Address - Fax:714-433-3100
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301090736207Q00000X
CAA110238207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine