MEDICARE: ERICKA MARIA VALENZUELA DO

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	245028	NY

General Provider Information

NPI Number	:	1780623678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICKA MARIA VALENZUELA DO

Provider Business Mailing Address
First Line	:	76 BONIFACE DR
Second Line	:
City	:	PINE BUSH
State	:	NY
Zip	:	12566-4612
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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	09/19/2022

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