Provider Demographics
NPI:1205395597
Name:WAHBA, VICTOR J
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:J
Last Name:WAHBA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-3902
Mailing Address - Country:US
Mailing Address - Phone:858-342-6243
Mailing Address - Fax:
Practice Address - Street 1:1637 THIRD AVE UNIT A
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-5823
Practice Address - Country:US
Practice Address - Phone:619-934-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23369183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist