Healthcare Provider Details

I. General information

NPI: 1487015574
Provider Name (Legal Business Name): NIDIA VALENCIA-RYMER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2016
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 E ARROW HWY
POMONA CA
91767-2535
US

IV. Provider business mailing address

831 E ARROW HWY
POMONA CA
91767-2535
US

V. Phone/Fax

Practice location:
  • Phone: 909-398-4383
  • Fax: 909-445-8936
Mailing address:
  • Phone: 900-398-4383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2301
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: