Provider Demographics
NPI:1891904892
Name:LEEFERS, VIKI JO (ARNP-BC)
Entity Type:Individual
Prefix:MS
First Name:VIKI
Middle Name:JO
Last Name:LEEFERS
Suffix:
Gender:F
Credentials:ARNP-BC
Other - Prefix:
Other - First Name:VIKI
Other - Middle Name:JO
Other - Last Name:AGUIRRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP-BC
Mailing Address - Street 1:525 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-5616
Mailing Address - Country:US
Mailing Address - Phone:619-585-4397
Mailing Address - Fax:619-585-4005
Practice Address - Street 1:525 3RD AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-5616
Practice Address - Country:US
Practice Address - Phone:619-585-4397
Practice Address - Fax:619-585-4005
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21490363LA2200X
WAAP30006086363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health