Provider Demographics
NPI:1316015688
Name:DEMARTINI, VICTORIA (PA-C)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:DEMARTINI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 E JULIAN ST
Mailing Address - Street 2:MEDICAL ADMINISTRATION DEPT.
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-4007
Mailing Address - Country:US
Mailing Address - Phone:408-918-2600
Mailing Address - Fax:408-795-1129
Practice Address - Street 1:55 E JULIAN ST
Practice Address - Street 2:MEDICAL ADMINISTRATION DEPT.
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-4007
Practice Address - Country:US
Practice Address - Phone:408-918-2600
Practice Address - Fax:408-795-1129
Is Sole Proprietor?:No
Enumeration Date:2006-12-02
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA10838363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant