Healthcare Provider Details

I. General information

NPI: 1437915154
Provider Name (Legal Business Name): VICTORIA VALENZUELA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2024
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W ELLIOT RD STE 109
TEMPE AZ
85284-1310
US

IV. Provider business mailing address

1 W ELLIOT RD STE 109
TEMPE AZ
85284-1310
US

V. Phone/Fax

Practice location:
  • Phone: 480-374-4341
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License NumberPTA-014227
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberPTA-014227
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA-014227
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License NumberPTA-014227
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: