Healthcare Provider Details

I. General information

NPI: 1417554338
Provider Name (Legal Business Name): DIANA VALENCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2020
Last Update Date: 05/01/2021
Certification Date: 05/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 W INA RD STE 151
TUCSON AZ
85704-1907
US

IV. Provider business mailing address

1631 W INA RD STE 151
TUCSON AZ
85704-1907
US

V. Phone/Fax

Practice location:
  • Phone: 520-585-5738
  • Fax:
Mailing address:
  • Phone: 520-585-5738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN170629
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number255369
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: