Provider Demographics
NPI:1982409157
Name:PENALOZA, VICTORIA ISABEL
Entity type:Individual
Prefix:MISS
First Name:VICTORIA
Middle Name:ISABEL
Last Name:PENALOZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 CONRADI ST # 466C
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32304-3439
Mailing Address - Country:US
Mailing Address - Phone:954-882-6041
Mailing Address - Fax:
Practice Address - Street 1:2331 HANSEN CT # 466C
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-4859
Practice Address - Country:US
Practice Address - Phone:850-320-6555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician