Healthcare Provider Details

I. General information

NPI: 1336698398
Provider Name (Legal Business Name): LIDIA VALADEZ-BECERRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2016
Last Update Date: 09/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3816 WOODRUFF AVE STE. 305
LONG BEACH CA
90808-2147
US

IV. Provider business mailing address

5912 BOLSA AVE STE 201
HUNTINGTON BEACH CA
92649-1146
US

V. Phone/Fax

Practice location:
  • Phone: 562-982-0050
  • Fax:
Mailing address:
  • Phone: 714-898-5732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA 8141
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: