MEDICARE: YAJAIRA CAMILA TIPAN VALDIVIEZO RT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2279S1500X	SNF/Subacute Care Registered Respiratory Therapist	49323	CA

General Provider Information

NPI Number	:	1033065198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAJAIRA CAMILA TIPAN VALDIVIEZO RT

Provider Business Mailing Address
First Line	:	6431 LAKE TAHOE CT
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92119-2534
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6431 LAKE TAHOE CT
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92119-2534
Country	:	US
Telephone Number	:	619-724-8780
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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