Individual
VICTORIA LEIGH TAKUBO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4610 KANAWHA AVE SW STE 401, SOUTH CHARLESTON, WV 25309-1367
(304) 768-7368
(304) 768-1829
Mailing address
4605 MACCORKLE AVE SW, SOUTH CHARLESTON, WV 25309-1311
(304) 414-4800
(304) 414-4801
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
01484
WV
363AS0400X
Surgical Physician Assistant
Primary
1484
WV
Other
Enumeration date
09/10/2010
Last updated
01/04/2022
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