1427311323 NPI number — MS. VICTORIA LYNN WHEATON-YOUNG FNP, BC

Table of content: MS. VICTORIA LYNN WHEATON-YOUNG FNP, BC (NPI 1427311323)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427311323 NPI number — MS. VICTORIA LYNN WHEATON-YOUNG FNP, BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHEATON-YOUNG
Provider First Name:
VICTORIA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
FNP, BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
YOUNG
Provider Other First Name:
VICKIE
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1427311323
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
516 WEST ATEN ROAD
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
IMPERIAL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-355-7730
Provider Business Mailing Address Fax Number:
760-355-7731

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1665 SOUTH IMPERIAL AVENUE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
EL CENTRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-592-4783
Provider Business Practice Location Address Fax Number:
760-545-0256
Provider Enumeration Date:
06/17/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  478956 20874 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 20874 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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