Healthcare Provider Details

I. General information

NPI: 1982173985
Provider Name (Legal Business Name): MONICA MARIA VALENZUELA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2018
Last Update Date: 11/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 MONROE AVE NW STE 140
GRAND RAPIDS MI
49505-4609
US

IV. Provider business mailing address

6826 WINDWATER CT
NORTON SHORES MI
49444-7736
US

V. Phone/Fax

Practice location:
  • Phone: 616-458-9520
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: