Healthcare Provider Details

I. General information

NPI: 1356004733
Provider Name (Legal Business Name): ANGELICA MONIQUE VALDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2021
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 WHITE LN
BAKERSFIELD CA
93309-7688
US

IV. Provider business mailing address

2433 BAY ST
BAKERSFIELD CA
93301-2711
US

V. Phone/Fax

Practice location:
  • Phone: 661-837-2198
  • Fax: 661-837-1262
Mailing address:
  • Phone: 661-742-6424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number91274
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: