Provider Demographics
NPI:1770603300
Name:PARRA, VICTOR JOSE
Entity type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:JOSE
Last Name:PARRA
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:VICTOR
Other - Middle Name:JOSE
Other - Last Name:PARRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:115 W CALIFORNIA BLVD
Mailing Address - Street 2:SUITE 156
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3005
Mailing Address - Country:US
Mailing Address - Phone:626-441-1500
Mailing Address - Fax:
Practice Address - Street 1:115 W CALIFORNIA BLVD
Practice Address - Street 2:SUITE 156
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3005
Practice Address - Country:US
Practice Address - Phone:626-441-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALA11398101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health