Basic Information
| Provider Information | |||||||||
| NPI: | 1821041419 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KONG SIBAL | ||||||||
| FirstName: | JEANNETTE | ||||||||
| MiddleName: | VALENZUELA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 INDEPENDENCE CIR | ||||||||
| Address2: | |||||||||
| City: | CHICO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959730258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308990143 | ||||||||
| FaxNumber: | 5308990142 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 INDEPENDENCE CIR | ||||||||
| Address2: | |||||||||
| City: | CHICO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959730258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308990143 | ||||||||
| FaxNumber: | 5308990142 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 10/26/2016 | ||||||||
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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 | 207Q00000X | A49593 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207QG0300X | A49593 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
No ID Information.