Healthcare Provider Details

I. General information

NPI: 1194453860
Provider Name (Legal Business Name): JOSE N. VALENCIA PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1398 SPERBER RD
EL CENTRO CA
92243-9621
US

IV. Provider business mailing address

100 BANAGAS CT
CALEXICO CA
92231-1743
US

V. Phone/Fax

Practice location:
  • Phone: 760-312-6464
  • Fax:
Mailing address:
  • Phone: 760-562-1895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number302507
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: