Healthcare Provider Details

I. General information

NPI: 1467084590
Provider Name (Legal Business Name): VALERIEANNE NAVALTA DELACRUZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date: 01/16/2024
Reactivation Date: 01/23/2024

III. Provider practice location address

220 CONCOURSE BLVD
SANTA ROSA CA
95403-8210
US

IV. Provider business mailing address

220 CONCOURSE BLVD
SANTA ROSA CA
95403-8210
US

V. Phone/Fax

Practice location:
  • Phone: 844-527-7369
  • Fax: 844-847-4943
Mailing address:
  • Phone: 844-527-7369
  • Fax: 844-847-4943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number68456
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number68456
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: