Healthcare Provider Details

I. General information

NPI: 1164543567
Provider Name (Legal Business Name): VICTORINE AKUH ATIABET LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6027 SYLVANER WAY
SAN JOSE CA
95120-1735
US

IV. Provider business mailing address

1324 S WINCHESTER BLVD 72
SAN JOSE CA
95128-4341
US

V. Phone/Fax

Practice location:
  • Phone: 408-268-1301
  • Fax: 408-927-9279
Mailing address:
  • Phone: 408-829-1203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN 201143
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: