Provider Demographics
NPI:1053564823
Name:KING PALENSCAR, VICTORIA MAY (PSYD)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:MAY
Last Name:KING PALENSCAR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:VICTORIA
Other - Middle Name:MAY
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 567
Mailing Address - Street 2:
Mailing Address - City:PATTON
Mailing Address - State:CA
Mailing Address - Zip Code:92369-0567
Mailing Address - Country:US
Mailing Address - Phone:909-425-7791
Mailing Address - Fax:
Practice Address - Street 1:3102 E HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:PATTON
Practice Address - State:CA
Practice Address - Zip Code:92369-7813
Practice Address - Country:US
Practice Address - Phone:909-425-7791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22236103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist