Basic Information
| Provider Information | |||||||||
| NPI: | 1396945754 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRANKER | ||||||||
| FirstName: | VICTOR | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | PSY.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | CALIFORNIA REHABILITATION CENTER P. | ||||||||
| Address2: | 5TH AND WESTERN AVE | ||||||||
| City: | NORCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928600991 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9517372683 | ||||||||
| FaxNumber: | 9512732974 | ||||||||
| Practice Location | |||||||||
| Address1: | 5TH ST & N WESTERN AVE | ||||||||
| Address2: | |||||||||
| City: | NORCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92860 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9517372683 | ||||||||
| FaxNumber: | 9512732974 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2007 | ||||||||
| LastUpdateDate: | 07/23/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PSY15530 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.