Provider Demographics
NPI:1639354087
Name:ENCISO, VICTORIA BACH (CGC)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:BACH
Last Name:ENCISO
Suffix:
Gender:F
Credentials:CGC
Other - Prefix:
Other - First Name:VICKY
Other - Middle Name:
Other - Last Name:ENCISO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CGC
Mailing Address - Street 1:7703 FLOYD CURL DR
Mailing Address - Street 2:MAIL CODE 7809
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3901
Mailing Address - Country:US
Mailing Address - Phone:210-562-5373
Mailing Address - Fax:210-562-5375
Practice Address - Street 1:7703 FLOYD CURL DR
Practice Address - Street 2:MAIL CODE 7809
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3901
Practice Address - Country:US
Practice Address - Phone:210-562-5373
Practice Address - Fax:210-562-5375
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2002098170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS