Healthcare Provider Details

I. General information

NPI: 1356469910
Provider Name (Legal Business Name): SYLVIA JOYCE VALENZUELA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 E 12TH ST
DOUGLAS AZ
85607-1936
US

IV. Provider business mailing address

1545 MISSION DR
DOUGLAS AZ
85607-1815
US

V. Phone/Fax

Practice location:
  • Phone: 520-364-2447
  • Fax: 520-805-5537
Mailing address:
  • Phone: 520-364-2447
  • Fax: 520-805-5537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRN021004
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: