Provider Demographics
NPI:1225108277
Name:LATIFSES, VICTORIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:
Last Name:LATIFSES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:LATIFSES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:10605 BALBOA BLVD
Mailing Address - Street 2:#100
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-6342
Mailing Address - Country:US
Mailing Address - Phone:818-832-2400
Mailing Address - Fax:818-366-7234
Practice Address - Street 1:10605 BALBOA BLVD
Practice Address - Street 2:#100
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6342
Practice Address - Country:US
Practice Address - Phone:818-832-2400
Practice Address - Fax:818-366-7234
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20486103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical