MEDICARE: DR. KRISTEN VALENCIA DERAY

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	390200000X	Student in an Organized Health Care Education/Training Program
2	2080P0208X	Pediatric Infectious Diseases Physician	T0656	TX

General Provider Information

NPI Number	:	1104210483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTEN VALENCIA DERAY

Provider Business Mailing Address
First Line	:	1102 BATES AVE STE 1120
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2698
Country	:	US
Telephone Number	:
Fax Number	:	614-722-6132

Provider Business Practice Location Address
First Line	:	1102 BATES AVE STE 1120
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2698
Country	:	US
Telephone Number	:	832-824-1780
Fax Number	:	614-722-6132

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

Provider Enumeration Date	:	03/24/2015
Last Update Date	:	06/16/2022

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Directions to “ DR. KRISTEN VALENCIA DERAY ” Practice Location

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