Basic Information
| Provider Information | |||||||||
| NPI: | 1912565417 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VALENZUELA | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | STEVEN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | I | ||||||||
| Credential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 13510 DITTMAR DR | ||||||||
| Address2: | |||||||||
| City: | WHITTIER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906052228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5623220997 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 160 S 7TH AVE | ||||||||
| Address2: | |||||||||
| City: | LA PUENTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917463211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6269618971 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2019 | ||||||||
| LastUpdateDate: | 06/17/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.