Healthcare Provider Details

I. General information

NPI: 1285581355
Provider Name (Legal Business Name): MIKENNA VALENCIA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15810 SATICOY ST
VAN NUYS CA
91406-3128
US

IV. Provider business mailing address

28939 OLD ADOBE LN
VALENCIA CA
91354-1551
US

V. Phone/Fax

Practice location:
  • Phone: 818-787-2113
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number27059
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: