Healthcare Provider Details

I. General information

NPI: 1922522788
Provider Name (Legal Business Name): ANALILA VALENCIA ND, MSOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

858 2ND ST
SANTA ROSA CA
95404-4610
US

IV. Provider business mailing address

858 2ND ST
SANTA ROSA CA
95404-4610
US

V. Phone/Fax

Practice location:
  • Phone: 877-587-4923
  • Fax:
Mailing address:
  • Phone: 877-587-4923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number18374
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number917
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: