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Contact Information

VICTORIA L TAKUBO, PA-C
4610 KANAWHA AVE SW STE 401
SOUTH CHARLESTON, WV25309-1367
 Phone: 304-768-7368
 Fax: 304-768-1829
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Surgical

363AS0400X 97 Physician Assistant
 

Medical

363AM0700X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for VICTORIA L TAKUBO · (Female)

NPI Number 1194032227
Status Active
Credentials PA-C (Physician Assistant-Certified)
Entity Individual
Enumeration date 09/10/2010
Last updated 01/04/2022 - About 4 years ago
Sole proprietor 1 No
Identifiers
  • WV License # 01484
  • WV License # 1484
Hospital affiliation(s)
  • BOONE MEMORIAL HOSPITAL - (Critical Access)
    701 MADISON AVENUE
    MADISON, WV 25130
  • CHARLESTON AREA MEDICAL CENTER - (Acute Care)
    501 MORRIS STREET
    CHARLESTON, WV 25301
  • THOMAS MEMORIAL HOSPITAL - (Acute Care)
    4605 MACCORKLE AVE SW
    SOUTH CHARLESTON, WV 25309
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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