MEDICARE: MRS. RAQUEL PINEDA VALENZUELA LVN

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	164X00000X	Licensed Vocational Nurse	VN196979	CA

General Provider Information

NPI Number	:	1528199908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RAQUEL PINEDA VALENZUELA LVN

Provider Business Mailing Address
First Line	:	39101 WHITE FIR LN
Second Line	:
City	:	PALMDALE
State	:	CA
Zip	:	93551-6001
Country	:	US
Telephone Number	:	661-947-5456
Fax Number	:

Provider Business Practice Location Address
First Line	:	190 SIERRA CT STE C8
Second Line	:
City	:	PALMDALE
State	:	CA
Zip	:	93550-7609
Country	:	US
Telephone Number	:	661-266-4783
Fax Number	:	661-266-1210

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

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	07/08/2007

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