Healthcare Provider Details

I. General information

NPI: 1740242452
Provider Name (Legal Business Name): VICTOR WALLENKAMPF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 12/29/2023
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 DOLBEER ST
EUREKA CA
95501-4736
US

IV. Provider business mailing address

1726 SPRING HILL LANE
BAYSIDE CA
95524-1461
US

V. Phone/Fax

Practice location:
  • Phone: 707-269-4250
  • Fax:
Mailing address:
  • Phone: 707-822-6161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD23323
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG82276
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: