Healthcare Provider Details

I. General information

NPI: 1326356072
Provider Name (Legal Business Name): VICTORIA LEMKIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 11/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18302 IRVINE BLVD STE 300
TUSTIN CA
92780-3435
US

IV. Provider business mailing address

18302 IRVINE BLVD STE 300
TUSTIN CA
92780-3435
US

V. Phone/Fax

Practice location:
  • Phone: 714-957-1004
  • Fax:
Mailing address:
  • Phone: 714-957-1004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number30802
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: