Healthcare Provider Details

I. General information

NPI: 1477764462
Provider Name (Legal Business Name): VICTORIA G LEBRON N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 01/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2937 BEYER BLVD
SAN DIEGO CA
92154-4604
US

IV. Provider business mailing address

340 4TH AVE STE 11
CHULA VISTA CA
91910-3813
US

V. Phone/Fax

Practice location:
  • Phone: 619-423-0343
  • Fax: 619-423-3746
Mailing address:
  • Phone: 619-422-6158
  • Fax: 619-422-2019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number228777
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number228777
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: