Healthcare Provider Details

I. General information

NPI: 1427938612
Provider Name (Legal Business Name): VANESSA VALENZUELA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2025
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 E SANTA CLARA ST
SAN JOSE CA
95116-2337
US

IV. Provider business mailing address

576 S 5TH ST
SAN JOSE CA
95112-5613
US

V. Phone/Fax

Practice location:
  • Phone: 408-240-0070
  • Fax:
Mailing address:
  • Phone: 408-240-0070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberY9611905
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: