Healthcare Provider Details

I. General information

NPI: 1396664934
Provider Name (Legal Business Name): DAISY VALENCIA VIVAR SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 E PRESS RD
SAN TAN VALLEY AZ
85140-5425
US

IV. Provider business mailing address

1110 E PRESS RD
SAN TAN VALLEY AZ
85140-5425
US

V. Phone/Fax

Practice location:
  • Phone: 480-245-8577
  • Fax: 213-603-3344
Mailing address:
  • Phone: 480-245-8577
  • Fax: 213-603-3344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA17620
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: