Individual
VICTORIA HENRIQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6 WOODLAND RD STE 202, SAINT HELENA, CA 94574
(707) 968-0670
Mailing address
6 WOODLAND RD STE 202, SAINT HELENA, CA 94574-9501
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA9106201
FL
363AS0400X
Surgical Physician Assistant
Primary
53883
CA
363AS0400X
Surgical Physician Assistant
PA9106201
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
FP210Y
MEDICARE
FL
Enumeration date
10/12/2011
Last updated
11/12/2018
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