Healthcare Provider Details

I. General information

NPI: 1437780186
Provider Name (Legal Business Name): ISAAC VALENZUELA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2020
Last Update Date: 01/31/2020
Certification Date: 01/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 E AIRPORT DR STE 150
SAN BERNARDINO CA
92408-3429
US

IV. Provider business mailing address

202 E AIRPORT DR STE 150
SAN BERNARDINO CA
92408-3429
US

V. Phone/Fax

Practice location:
  • Phone: 877-206-1009
  • Fax:
Mailing address:
  • Phone: 877-206-1009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: