Basic Information
| Provider Information | |||||||||
| NPI: | 1679103402 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VALENCIA | ||||||||
| FirstName: | VERONICA | ||||||||
| MiddleName: | ALEJANDRA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5544 TYLER AVE | ||||||||
| Address2: | |||||||||
| City: | ARCADIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910065635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262348286 | ||||||||
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| Practice Location | |||||||||
| Address1: | 902 S MYRTLE AVE | ||||||||
| Address2: | |||||||||
| City: | MONROVIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910163427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263573258 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/21/2020 | ||||||||
| LastUpdateDate: | 02/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 390200000X | CA | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.