Healthcare Provider Details

I. General information

NPI: 1023296589
Provider Name (Legal Business Name): LEI M. VALENZUELA PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 02/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 FERGUSON DR SUITE 210-4
COMMERCE CA
90022-5164
US

IV. Provider business mailing address

5555 FERGUSON DR SUITE 210-4
COMMERCE CA
90022-5164
US

V. Phone/Fax

Practice location:
  • Phone: 323-869-8231
  • Fax: 323-869-8230
Mailing address:
  • Phone: 323-869-8231
  • Fax: 323-869-8230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number484555
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: