Provider Demographics
NPI:1720164387
Name:CALLIHAN, VICTORIA A (NP)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:A
Last Name:CALLIHAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:A
Other - Last Name:DONARUMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8808 BALBOA AVE
Mailing Address - Street 2:TRICARE OUTPATIENT CLINIC
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1592
Mailing Address - Country:US
Mailing Address - Phone:619-645-0151
Mailing Address - Fax:
Practice Address - Street 1:8808 BALBOA AVE
Practice Address - Street 2:TRICARE OUTPATIENT CLINIC
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1592
Practice Address - Country:US
Practice Address - Phone:619-645-0151
Practice Address - Fax:619-645-0193
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16517363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily