Provider Demographics
NPI:1881680320
Name:LALAMA, VICTOR HUGO (DC)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:HUGO
Last Name:LALAMA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8601 WHEELER AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-3854
Mailing Address - Country:US
Mailing Address - Phone:909-822-2014
Mailing Address - Fax:909-823-5790
Practice Address - Street 1:8601 WHEELER AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-3854
Practice Address - Country:US
Practice Address - Phone:909-822-2014
Practice Address - Fax:909-823-5790
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2009-08-06
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
CADC 11072111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3404712OtherMEDICAL
CA3404712OtherMEDICAL
CADC0192910Medicare ID - Type Unspecified