Healthcare Provider Details

I. General information

NPI: 1871412163
Provider Name (Legal Business Name): KRISTINA ANNE VALMEO PROTACIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S CENTRAL AVE STE 108
GLENDALE CA
91204-2785
US

IV. Provider business mailing address

2042 PARKMOUNT DR
GLENDALE CA
91206-1745
US

V. Phone/Fax

Practice location:
  • Phone: 818-500-8739
  • Fax:
Mailing address:
  • Phone: 818-390-4681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95040488
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: