Provider Demographics
NPI:1619634565
Name:HORTIZUELA, VOLTAIRE MAGAOAY I
Entity Type:Individual
Prefix:
First Name:VOLTAIRE
Middle Name:MAGAOAY
Last Name:HORTIZUELA
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 SUTHERLAND DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-4468
Mailing Address - Country:US
Mailing Address - Phone:209-518-8505
Mailing Address - Fax:
Practice Address - Street 1:541 SUTHERLAND DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-4468
Practice Address - Country:US
Practice Address - Phone:209-518-8505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-25
Last Update Date:2021-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41757167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician