Healthcare Provider Details

I. General information

NPI: 1831191055
Provider Name (Legal Business Name): VALERIE A VALENZUELA O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5560 W 44TH AVE
DENVER CO
80212-7338
US

IV. Provider business mailing address

5560 W 44TH AVE
DENVER CO
80212-7338
US

V. Phone/Fax

Practice location:
  • Phone: 303-421-2424
  • Fax: 303-421-2155
Mailing address:
  • Phone: 303-421-2424
  • Fax: 303-421-2155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1518
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: