Healthcare Provider Details

I. General information

NPI: 1346690518
Provider Name (Legal Business Name): REIMUS VALENCIA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2016
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6970 E CHAUNCEY LN STE 100
PHOENIX AZ
85054-5158
US

IV. Provider business mailing address

6970 E CHAUNCEY LN STE 100
PHOENIX AZ
85054-5158
US

V. Phone/Fax

Practice location:
  • Phone: 602-788-7211
  • Fax: 602-788-1890
Mailing address:
  • Phone: 602-788-7211
  • Fax: 602-788-1890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number010358
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number50101022350
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number34.014067
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: