=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417959313
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VALLEYTECH, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2005
-----------------------------------------------------
Last Update Date | 03/31/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4873 WEST LN
-----------------------------------------------------
City | STOCKTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95210-4548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-472-1136
-----------------------------------------------------
Fax | 209-472-1138
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 77843
-----------------------------------------------------
City | STOCKTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95267-1143
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-472-1136
-----------------------------------------------------
Fax | 209-472-1138
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. UKPONG UWEH
-----------------------------------------------------
Credential | BS
-----------------------------------------------------
Telephone | 209-472-1136
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BP3500X
-----------------------------------------------------
Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
-----------------------------------------------------
License Number | DME02917F
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------