Healthcare Provider Details

I. General information

NPI: 1447880588
Provider Name (Legal Business Name): MS. NICOLE VALENCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2020
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 BERCUT DR STE B
SACRAMENTO CA
95811-0115
US

IV. Provider business mailing address

3425 COFFEE RD STE C2
MODESTO CA
95355-1582
US

V. Phone/Fax

Practice location:
  • Phone: 916-443-2479
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: