Provider Demographics
NPI:1558545483
Name:RIVERA, VICTORIA JULIA
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:JULIA
Last Name:RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:VICTORIA
Other - Middle Name:JULIA
Other - Last Name:VIRUET-RIVERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:927 E CHASE AVE
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-7607
Mailing Address - Country:US
Mailing Address - Phone:619-579-1715
Mailing Address - Fax:
Practice Address - Street 1:927 E CHASE AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-7607
Practice Address - Country:US
Practice Address - Phone:619-579-1715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program