Provider Demographics
NPI:1700131406
Name:JORRIN, VICTOR MICHAEL
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:MICHAEL
Last Name:JORRIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 SUNRISE AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-4853
Mailing Address - Country:US
Mailing Address - Phone:702-445-6594
Mailing Address - Fax:702-445-6970
Practice Address - Street 1:3320 SUNRISE AVE STE 111
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-4853
Practice Address - Country:US
Practice Address - Phone:702-445-6594
Practice Address - Fax:702-445-6970
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health