Healthcare Provider Details

I. General information

NPI: 1750177903
Provider Name (Legal Business Name): VANESSA NICOLE VALENZUELA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13400 RIVERSIDE DR STE 209
SHERMAN OAKS CA
91423-2545
US

IV. Provider business mailing address

1829 E 106TH ST
LOS ANGELES CA
90002-3619
US

V. Phone/Fax

Practice location:
  • Phone: 323-215-5709
  • Fax: 323-215-5709
Mailing address:
  • Phone: 323-215-5709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: