Provider Demographics
NPI:1649560632
Name:LYO, VICTORIA (MD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:LYO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 STOCKTON BLVD. DEPARTMENT OF SURGERY
Mailing Address - Street 2:NAOB SUITE 6113
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2201
Mailing Address - Country:US
Mailing Address - Phone:916-703-4459
Mailing Address - Fax:916-703-4452
Practice Address - Street 1:2315 STOCKTON BLVD. DEPARTMENT OF SURGERY
Practice Address - Street 2:NAOB SUITE 6113
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2201
Practice Address - Country:US
Practice Address - Phone:916-703-4459
Practice Address - Fax:916-703-4452
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD188154208600000X
390200000X
CAA123485208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORMD188154OtherOREGON MEDICAL LICENSE