Provider Demographics
NPI:1467786103
Name:WOSTENBERG, VICTORIA (DPT)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:WOSTENBERG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4290 LIVERMORE PL
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-2731
Mailing Address - Country:US
Mailing Address - Phone:714-952-4742
Mailing Address - Fax:
Practice Address - Street 1:1525 SUPERIOR AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3639
Practice Address - Country:US
Practice Address - Phone:949-650-1410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35996225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist