Healthcare Provider Details

I. General information

NPI: 1912032277
Provider Name (Legal Business Name): MS. VICKY MOKEH SYLVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 S 14TH ST
SAN JOSE CA
95112-2015
US

IV. Provider business mailing address

1922 THE ALAMEDA STE 316
SAN JOSE CA
95126-1461
US

V. Phone/Fax

Practice location:
  • Phone: 408-998-3293
  • Fax: 408-642-6052
Mailing address:
  • Phone: 408-261-7777
  • Fax: 408-642-6052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number41648
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: