Provider Demographics
NPI:1477764462
Name:LEBRON, VICTORIA G (NP)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:G
Last Name:LEBRON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:340 4TH AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-3813
Mailing Address - Country:US
Mailing Address - Phone:619-422-6158
Mailing Address - Fax:619-422-2019
Practice Address - Street 1:2937 BEYER BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-4604
Practice Address - Country:US
Practice Address - Phone:619-423-0343
Practice Address - Fax:619-423-3746
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA228777207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA228777OtherLICENSE