Provider Demographics
NPI:1831311828
Name:HAASE, VIKKI LYNN
Entity Type:Individual
Prefix:MS
First Name:VIKKI
Middle Name:LYNN
Last Name:HAASE
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:VIKKI
Other - Middle Name:LYNN
Other - Last Name:TROMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:43167 MATERA CT
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-9137
Mailing Address - Country:US
Mailing Address - Phone:760-484-8483
Mailing Address - Fax:
Practice Address - Street 1:251 LANDIS AVE STE 201
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2629
Practice Address - Country:US
Practice Address - Phone:619-498-8450
Practice Address - Fax:619-498-8453
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAA394965225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist