Healthcare Provider Details

I. General information

NPI: 1114480340
Provider Name (Legal Business Name): NINFA A VALENZUELA CDPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NINFA A ANTONSON

II. Dates (important events)

Enumeration Date: 04/14/2019
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7510 W DESCHUTES PL
KENNEWICK WA
99336-7719
US

IV. Provider business mailing address

5834 W 40TH CT
KENNEWICK WA
99338-5638
US

V. Phone/Fax

Practice location:
  • Phone: 509-579-0738
  • Fax:
Mailing address:
  • Phone: 509-391-8502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCO60935383
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: