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General NPI Number Information
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NPI Number | 1508876442
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Entity Type | Organization
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Legal Business Name | CARLOS VALENZUELA
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 09/09/2008
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Provider Practice Location Address
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Address Line | 4224 OHIO ST
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City | SAN DIEGO
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State | CA
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Zip | 92104-1320
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Country | US
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Telephone | 619-280-9174
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Fax | 619-280-9286
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Provider Business Mailing Address
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Address Line | 4224 OHIO ST
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City | SAN DIEGO
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State | CA
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Zip | 92104-1320
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Country | US
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Telephone | 619-280-9174
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Fax | 619-280-9286
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Authorized Official
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Title or Position | CERTIFIED ORTHOTIST OWNER
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Name | CARLOS VALENZUELA
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Credential |
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Telephone | 619-280-9174
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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