Healthcare Provider Details

I. General information

NPI: 1295745958
Provider Name (Legal Business Name): ADELA MERCEDES VALENZUELA CERTIFIED WON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 11/03/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12021 JACARANDA AVE
HESPERIA CA
92345-4978
US

IV. Provider business mailing address

15010 FIR STREET
HESPERIA CA
92345-4316
US

V. Phone/Fax

Practice location:
  • Phone: 760-956-5334
  • Fax:
Mailing address:
  • Phone: 760-488-1209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0900X
TaxonomyEnterostomal Therapy Registered Nurse
License Number430539
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19668
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: