Provider Demographics
NPI:1972726131
Name:SIBAYAN, VICTORIA YVONNE (MFT)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:YVONNE
Last Name:SIBAYAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 W TOKAY ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-3845
Mailing Address - Country:US
Mailing Address - Phone:209-331-2070
Mailing Address - Fax:
Practice Address - Street 1:1209 W TOKAY ST
Practice Address - Street 2:SUITE 5
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-3845
Practice Address - Country:US
Practice Address - Phone:209-331-2070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41239106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist