Provider Demographics
NPI:1730500166
Name:MACAGBA, VICTORIA REYES (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:REYES
Last Name:MACAGBA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10075 SILVERADO CT
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-1600
Mailing Address - Country:US
Mailing Address - Phone:619-449-9104
Mailing Address - Fax:
Practice Address - Street 1:10075 SILVERADO CT
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-1600
Practice Address - Country:US
Practice Address - Phone:619-449-9104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAFE32684208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAFE32684OtherTHE MEDICAL BOARD OF CALIFORNIA