MEDICARE: DR ERICKA M VALENZUELA MEDICAL OFFICE, PLLC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1699325761
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR ERICKA M VALENZUELA MEDICAL OFFICE, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 1613
Second Line	:
City	:	PINE BUSH
State	:	NY
Zip	:	12566-1613
Country	:	US
Telephone Number	:	845-545-6212
Fax Number	:	845-345-6212

Provider Business Practice Location Address
First Line	:	76 BONIFACE DR STE 1
Second Line	:
City	:	PINE BUSH
State	:	NY
Zip	:	12566-4611
Country	:	US
Telephone Number	:	845-545-6212
Fax Number	:	845-345-6212

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ERICKA MARIA VALENZUELA
Credential	:	DO
Telephone Number	:	845-545-6212

Provider Enumeration Date	:	09/19/2019
Last Update Date	:	09/19/2019

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