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General NPI Number Information
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NPI Number | 1619562402
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Entity Type | Individual
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Provider Name | VICTORIA SEIBERLICH PTA
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Gender | Female
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Dates
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Enumeration Date | 03/04/2021
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Last Update Date | 03/04/2021
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Provider Practice Location Address
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Address Line | 1100 FLYNN RD STE 207
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City | CAMARILLO
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State | CA
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Zip | 93012-8737
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Country | US
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Telephone | 805-388-5678
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Fax |
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Provider Business Mailing Address
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Address Line | 1552 PATRICIA AVE APT 445
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City | SIMI VALLEY
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State | CA
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Zip | 93065-0468
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Country | US
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Telephone | 651-528-9657
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 50995
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License Number State | CA
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