Healthcare Provider Details

I. General information

NPI: 1053959437
Provider Name (Legal Business Name): VICTORIA KAITLIN SAENZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2019
Last Update Date: 11/27/2023
Certification Date: 12/16/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12235 BEACH BLVD STE 100
STANTON CA
90680-3943
US

IV. Provider business mailing address

1061 E BROADWAY APT 206
LONG BEACH CA
90802-3418
US

V. Phone/Fax

Practice location:
  • Phone: 714-202-0118
  • Fax:
Mailing address:
  • Phone: 626-586-2809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberF7629121
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: