1487806071 NPI number — MISS VICTORIA DASALLA PUNTANILLA LVN

Table of content: MISS VICTORIA DASALLA PUNTANILLA LVN (NPI 1487806071)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487806071 NPI number — MISS VICTORIA DASALLA PUNTANILLA LVN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PUNTANILLA
Provider First Name:
VICTORIA
Provider Middle Name:
DASALLA
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
LVN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EVANGELISTA
Provider Other First Name:
VICTORIA
Provider Other Middle Name:
PUNTANILLA
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
LVN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1487806071
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
831 BREVINS LOOP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95125
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-888-6908
Provider Business Mailing Address Fax Number:
408-266-7850

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
991 CLYDE AVENUE
Provider Second Line Business Practice Location Address:
VALLEY HOUSE CARE CENTER
Provider Business Practice Location Address City Name:
SANTA CLARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-988-7666
Provider Business Practice Location Address Fax Number:
408-988-0863
Provider Enumeration Date:
10/15/2008

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: 164X00000X , with the licence number:  VN198705 , 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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