Basic Information
| Provider Information | |||||||||
| NPI: | 1144671132 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BELLA-VALENZUELA | ||||||||
| FirstName: | JAYDA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11351 JAMES WATT DR | ||||||||
| Address2: | STE A | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799366605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9158496602 | ||||||||
| FaxNumber: | 9158496603 | ||||||||
| Practice Location | |||||||||
| Address1: | 11351 JAMES WATT DR STE A | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799366605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9158496602 | ||||||||
| FaxNumber: | 9158496603 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2016 | ||||||||
| LastUpdateDate: | 06/30/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0400X | TX | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
No ID Information.