Provider Demographics
NPI:1386382737
Name:ESTOQUE, VICTORIA MAEVE BAMBA (SLPA)
Entity type:Individual
Prefix:
First Name:VICTORIA MAEVE
Middle Name:BAMBA
Last Name:ESTOQUE
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8405 RIO SAN DIEGO DR APT 5437
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-5695
Mailing Address - Country:US
Mailing Address - Phone:201-532-4499
Mailing Address - Fax:
Practice Address - Street 1:7525 METROPOLITAN DR STE 308
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4412
Practice Address - Country:US
Practice Address - Phone:619-692-0622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant