Provider Demographics
NPI:1487806071
Name:PUNTANILLA, VICTORIA DASALLA (LVN)
Entity type:Individual
Prefix:MISS
First Name:VICTORIA
Middle Name:DASALLA
Last Name:PUNTANILLA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MISS
Other - First Name:VICTORIA
Other - Middle Name:PUNTANILLA
Other - Last Name:EVANGELISTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:831 BREVINS LOOP
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125
Mailing Address - Country:US
Mailing Address - Phone:408-888-6908
Mailing Address - Fax:408-266-7850
Practice Address - Street 1:991 CLYDE AVENUE
Practice Address - Street 2:VALLEY HOUSE CARE CENTER
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054
Practice Address - Country:US
Practice Address - Phone:408-988-7666
Practice Address - Fax:408-988-0863
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN198705164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse