Provider Demographics
NPI:1578881447
Name:PENCHUK, VIKTORIA (MA)
Entity Type:Individual
Prefix:
First Name:VIKTORIA
Middle Name:
Last Name:PENCHUK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 55602
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91385-0602
Mailing Address - Country:US
Mailing Address - Phone:661-435-0140
Mailing Address - Fax:
Practice Address - Street 1:18345 VENTURA BLVD
Practice Address - Street 2:#300
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4232
Practice Address - Country:US
Practice Address - Phone:661-435-0140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC48067106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist