Provider Demographics
NPI:1720672207
Name:MORON, VICTOR ALFONSO
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:ALFONSO
Last Name:MORON
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 1:648 S INDIANA ST
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-7821
Mailing Address - Country:US
Mailing Address - Phone:559-339-8238
Mailing Address - Fax:
Practice Address - Street 1:1150 E SEQUOIA AVE
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-4508
Practice Address - Country:US
Practice Address - Phone:559-556-0030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Multi-Specialty