Healthcare Provider Details

I. General information

NPI: 1003200619
Provider Name (Legal Business Name): ORLANDO SANTIAGO VALENZUELA JR. AGNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2015
Last Update Date: 10/12/2021
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 N COX ST STE 6
ASHEBORO NC
27203-5514
US

IV. Provider business mailing address

4006 LONGBOW CT
JAMESTOWN NC
27282-7710
US

V. Phone/Fax

Practice location:
  • Phone: 336-629-2201
  • Fax:
Mailing address:
  • Phone: 336-317-5348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5007542
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: