Healthcare Provider Details

I. General information

NPI: 1497670749
Provider Name (Legal Business Name): KRISTINA VALENCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 1/2 KENTUCKY ST STE E
PETALUMA CA
94952-2925
US

IV. Provider business mailing address

4679 CHILENO VALLEY RD
PETALUMA CA
94952-9429
US

V. Phone/Fax

Practice location:
  • Phone: 707-835-4823
  • Fax:
Mailing address:
  • Phone: 707-721-2045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: