Healthcare Provider Details

I. General information

NPI: 1104210483
Provider Name (Legal Business Name): DR. KRISTEN VALENCIA DERAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2015
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 BATES AVE STE 1120
HOUSTON TX
77030-2698
US

IV. Provider business mailing address

1102 BATES AVE STE 1120
HOUSTON TX
77030-2698
US

V. Phone/Fax

Practice location:
  • Phone: 832-824-1780
  • Fax: 614-722-6132
Mailing address:
  • Phone:
  • Fax: 614-722-6132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberT0656
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: