Healthcare Provider Details

I. General information

NPI: 1174802581
Provider Name (Legal Business Name): JOVITA LAYON VALENZUELA LVN, LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2011
Last Update Date: 08/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USAG JAPAN UNIT 45013 BOX 2415
APO AP
96338-5013
US

IV. Provider business mailing address

USAG JAPAN UNIT 45013 BOX 2415
APO AP
96338-5013
US

V. Phone/Fax

Practice location:
  • Phone: 315-263-4128
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN5155866
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN147139
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: