Healthcare Provider Details

I. General information

NPI: 1730955147
Provider Name (Legal Business Name): VICTOR JUNIORBOY WHITFIELD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 BERCUT DR STE C
SACRAMENTO CA
95811-0110
US

IV. Provider business mailing address

3780 ROSIN CT STE 110
SACRAMENTO CA
95834-1698
US

V. Phone/Fax

Practice location:
  • Phone: 916-363-1553
  • Fax: 916-363-1638
Mailing address:
  • Phone: 916-441-0226
  • Fax: 916-441-0286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: