Provider Demographics
NPI:1528318946
Name:VICTORIO, JOSEPH MANGUNARY (MOT / OTR / L)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MANGUNARY
Last Name:VICTORIO
Suffix:
Gender:M
Credentials:MOT / OTR / L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6247 CARSON HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139
Mailing Address - Country:US
Mailing Address - Phone:702-412-9171
Mailing Address - Fax:
Practice Address - Street 1:1660 COLUMBIAN WAY SOUTH
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144
Practice Address - Country:US
Practice Address - Phone:206-762-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0763225X00000X
CA13362225X00000X
MD1064302225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist