Healthcare Provider Details

I. General information

NPI: 1154041812
Provider Name (Legal Business Name): CIARRA ANN VALADEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 ELTON HILLS LN NW
ROCHESTER MN
55901-3577
US

IV. Provider business mailing address

19 7TH ST NE
ROCHESTER MN
55906-3644
US

V. Phone/Fax

Practice location:
  • Phone: 507-282-1009
  • Fax:
Mailing address:
  • Phone: 785-248-9305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB822574
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: