Healthcare Provider Details

I. General information

NPI: 1235607292
Provider Name (Legal Business Name): AMBER LEEANN VALENZUELA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2018
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 E SOUTHERN AVE STE 101
MESA AZ
85204-5419
US

IV. Provider business mailing address

2345 E SOUTHERN AVE STE 101
MESA AZ
85204-5419
US

V. Phone/Fax

Practice location:
  • Phone: 480-892-2345
  • Fax: 480-926-0495
Mailing address:
  • Phone: 480-892-2345
  • Fax: 480-926-0495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7571
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: