=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316561756
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LUZ VALENZUELA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2020
-----------------------------------------------------
Last Update Date | 06/01/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9745 LAUREL CANYON BLVD STE A
-----------------------------------------------------
City | ARLETA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91331-4115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-869-5000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22314 COHASSET ST
-----------------------------------------------------
City | CANOGA PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91303-1033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-310-5740
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 126800000X
-----------------------------------------------------
Taxonomy Name | Dental Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------