Healthcare Provider Details

I. General information

NPI: 1841660669
Provider Name (Legal Business Name): VICTOR TAMAYO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2015
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 IOWA AVE STE 101
RIVERSIDE CA
92507-7428
US

IV. Provider business mailing address

2020 IOWA AVE STE 101
RIVERSIDE CA
92507-7428
US

V. Phone/Fax

Practice location:
  • Phone: 951-580-1026
  • Fax:
Mailing address:
  • Phone: 951-580-1026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: