Provider Demographics
NPI:1316378011
Name:DE JESUS, MARIA VICTORIA ABUAN (PT)
Entity Type:Individual
Prefix:MS
First Name:MARIA VICTORIA
Middle Name:ABUAN
Last Name:DE JESUS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:MA. VICTORIA
Other - Middle Name:ABUAN
Other - Last Name:DE JESUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:4560 SE INTERNATIONAL WAY
Mailing Address - Street 2:STE. 100
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222
Mailing Address - Country:US
Mailing Address - Phone:971-206-5200
Mailing Address - Fax:971-206-5203
Practice Address - Street 1:1900 ATRIUM PARKWAY
Practice Address - Street 2:MEADOWS OF NAPA VALLEY, REHAB SERVICES DEPT.
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559
Practice Address - Country:US
Practice Address - Phone:707-257-4957
Practice Address - Fax:707-257-6915
Is Sole Proprietor?:No
Enumeration Date:2013-12-05
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40691225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist