Healthcare Provider Details

I. General information

NPI: 1013583251
Provider Name (Legal Business Name): VICTORIA MARIE RALPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2021
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 S MELROSE DR
VISTA CA
92081-6627
US

IV. Provider business mailing address

745 BREEZE HILL RD APT 623
VISTA CA
92081-4339
US

V. Phone/Fax

Practice location:
  • Phone: 619-409-5000
  • Fax:
Mailing address:
  • Phone: 630-347-6010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSB94028291
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: