Healthcare Provider Details

I. General information

NPI: 1174469662
Provider Name (Legal Business Name): KEVIN RANGEL VICTORIANO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 MERIDIAN AVE # 302
SAN JOSE CA
95125-5350
US

IV. Provider business mailing address

1263 DONCASTER WAY
SAN JOSE CA
95127-4005
US

V. Phone/Fax

Practice location:
  • Phone: 669-214-7569
  • Fax:
Mailing address:
  • Phone: 669-214-7569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: