Provider Demographics
NPI:1740516004
Name:MERENDA, VICTORIA E
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:E
Last Name:MERENDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14566 SEVENTH ST
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-4214
Mailing Address - Country:US
Mailing Address - Phone:949-770-6022
Mailing Address - Fax:949-770-7084
Practice Address - Street 1:24 HAMMOND
Practice Address - Street 2:UNIT C
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-1680
Practice Address - Country:US
Practice Address - Phone:949-770-6022
Practice Address - Fax:949-770-7084
Is Sole Proprietor?:No
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36005225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist