Healthcare Provider Details

I. General information

NPI: 1225775372
Provider Name (Legal Business Name): JOHN MELVIN WONG VALENZUELA NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 W LA VETA AVE STE 105
ORANGE CA
92868-3930
US

IV. Provider business mailing address

845 W LA VETA AVE STE 105
ORANGE CA
92868-3930
US

V. Phone/Fax

Practice location:
  • Phone: 714-289-6565
  • Fax: 714-289-6571
Mailing address:
  • Phone: 714-289-6565
  • Fax: 714-289-6571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95020509
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: