Basic Information
| Provider Information | |||||||||
| NPI: | 1255056388 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | UHATAFE | ||||||||
| FirstName: | VICTORIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2158 SOLANO WAY | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945204700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7279673765 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2158 SOLANO WAY | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945204700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9256905710 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2022 | ||||||||
| LastUpdateDate: | 10/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 720128 | CA | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.