Provider Demographics
NPI:1629286943
Name:RABOW, VICTORIA ELLEN
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:ELLEN
Last Name:RABOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23632 CALABASAS RD
Mailing Address - Street 2:202
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1553
Mailing Address - Country:US
Mailing Address - Phone:818-591-8270
Mailing Address - Fax:818-591-8271
Practice Address - Street 1:23632 CALABASAS RD
Practice Address - Street 2:202
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1553
Practice Address - Country:US
Practice Address - Phone:818-591-8270
Practice Address - Fax:818-591-8271
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 13518103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY 135180Medicaid
CAPSY 135180Medicaid
CAR16707Medicare UPIN