Provider Demographics
NPI:1689047953
Name:VITOR, MARIARUBY (RPH)
Entity Type:Individual
Prefix:
First Name:MARIARUBY
Middle Name:
Last Name:VITOR
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12717 GLENOAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-4749
Mailing Address - Country:US
Mailing Address - Phone:818-367-6116
Mailing Address - Fax:818-364-6712
Practice Address - Street 1:12717 GLENOAKS BLVD
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-4749
Practice Address - Country:US
Practice Address - Phone:818-367-6116
Practice Address - Fax:818-364-6712
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52955183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist