Healthcare Provider Details

I. General information

NPI: 1841863149
Provider Name (Legal Business Name): SCOTT DANIEL VALENZUELA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2021
Last Update Date: 02/28/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 E RIVER PARK PL W
FRESNO CA
93720-1551
US

IV. Provider business mailing address

20 E RIVER PARK PL W
FRESNO CA
93720-1551
US

V. Phone/Fax

Practice location:
  • Phone: 559-256-4950
  • Fax:
Mailing address:
  • Phone: 559-256-4950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95067570
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95002316
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: