Provider Demographics
NPI:1467783936
Name:LEONICHEV, VICTORIA BORISIVNA (RDCS)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:BORISIVNA
Last Name:LEONICHEV
Suffix:
Gender:F
Credentials:RDCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5260 CORTEEN PL APT 3
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-2563
Mailing Address - Country:US
Mailing Address - Phone:818-760-0882
Mailing Address - Fax:818-760-0882
Practice Address - Street 1:5260 CORTEEN PL APT 3
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-2563
Practice Address - Country:US
Practice Address - Phone:818-760-0882
Practice Address - Fax:818-760-0882
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-23
Last Update Date:2010-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAARDMS#95804174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist