Provider Demographics
NPI:1801608542
Name:MULLINAX, VICTORIA AULLISIANA
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:AULLISIANA
Last Name:MULLINAX
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 1:13755 W MAUNA LOA LN
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-8382
Mailing Address - Country:US
Mailing Address - Phone:480-930-0487
Mailing Address - Fax:
Practice Address - Street 1:13755 W MAUNA LOA LN
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-8382
Practice Address - Country:US
Practice Address - Phone:480-930-0487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician