Healthcare Provider Details

I. General information

NPI: 1013348507
Provider Name (Legal Business Name): VALERIE O. AJIDUAH PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2013
Last Update Date: 03/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3946 NORWOOD AVE
SACRAMENTO CA
95838-1092
US

IV. Provider business mailing address

625 FAIR OAKS AVE STE 270
SOUTH PASADENA CA
91030-5801
US

V. Phone/Fax

Practice location:
  • Phone: 916-564-0521
  • Fax: 877-860-2907
Mailing address:
  • Phone: 626-346-2455
  • Fax: 626-639-3005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number51325
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: