Healthcare Provider Details

I. General information

NPI: 1114154747
Provider Name (Legal Business Name): ELIZABETH ANNE VALJALO RN, MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH ANNE SHERWOOD RN, MSN, FNP

II. Dates (important events)

Enumeration Date: 06/22/2009
Last Update Date: 02/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 FLORIDA AVE
MODESTO CA
95350-4408
US

IV. Provider business mailing address

5925 W LAS POSITAS BLVD STE 100
PLEASANTON CA
94588-8537
US

V. Phone/Fax

Practice location:
  • Phone: 209-574-1365
  • Fax: 209-574-1372
Mailing address:
  • Phone: 925-201-6011
  • Fax: 925-417-1503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18966
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: