Healthcare Provider Details

I. General information

NPI: 1811427818
Provider Name (Legal Business Name): DAVID ARTHUR VALENCIA LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 NW 4TH ST
GRESHAM OR
97030-5306
US

IV. Provider business mailing address

1490 NW 4TH ST
GRESHAM OR
97030-5306
US

V. Phone/Fax

Practice location:
  • Phone: 503-839-5510
  • Fax:
Mailing address:
  • Phone: 503-957-1916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC183543
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: