Healthcare Provider Details

I. General information

NPI: 1952626475
Provider Name (Legal Business Name): ALEXANDRA GRACE VALENTIN RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2010
Last Update Date: 03/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 S 6TH AVE
TUCSON AZ
85723-0001
US

IV. Provider business mailing address

580 S STEPHANIE LOOP
TUCSON AZ
85745-3801
US

V. Phone/Fax

Practice location:
  • Phone: 520-792-1450
  • Fax:
Mailing address:
  • Phone: 520-393-9689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number009261
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: