Healthcare Provider Details

I. General information

NPI: 1326890476
Provider Name (Legal Business Name): GLORIA KANANI VALLEDOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GLORIA KANANI VALLEDOR

II. Dates (important events)

Enumeration Date: 04/02/2024
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 BECK AVE
FAIRFIELD CA
94533-6804
US

IV. Provider business mailing address

419 WOODHAVEN DR
VACAVILLE CA
95687-5941
US

V. Phone/Fax

Practice location:
  • Phone: 707-784-8129
  • Fax:
Mailing address:
  • Phone: 786-856-6222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: