Healthcare Provider Details

I. General information

NPI: 1144281270
Provider Name (Legal Business Name): RAMONCITO VALENCIA PEDRO SUB-IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 ALDEN CT
VIRGINIA BEACH VA
23462-7458
US

IV. Provider business mailing address

900 ALDEN CT
VIRGINIA BEACH VA
23462-7458
US

V. Phone/Fax

Practice location:
  • Phone: 757-443-7665
  • Fax:
Mailing address:
  • Phone: 757-443-7665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: