Provider Demographics
NPI:1366622441
Name:MACY, VICTOR
Entity type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:
Last Name:MACY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7504
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95604-7504
Mailing Address - Country:US
Mailing Address - Phone:530-823-5893
Mailing Address - Fax:530-823-5471
Practice Address - Street 1:98 GUM LN
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-5511
Practice Address - Country:US
Practice Address - Phone:530-823-5893
Practice Address - Fax:530-823-5471
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAN0782128172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTN00600FOtherMEDI-CAL