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General NPI Number Information
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NPI Number | 1699325761
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Entity Type | Organization
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Legal Business Name | DR ERICKA M VALENZUELA MEDICAL OFFICE, PLLC
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Dates
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Enumeration Date | 09/19/2019
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Last Update Date | 09/19/2019
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Provider Practice Location Address
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Address Line | 76 BONIFACE DR STE 1
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City | PINE BUSH
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State | NY
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Zip | 12566-4611
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Country | US
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Telephone | 845-545-6212
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Fax | 845-345-6212
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Provider Business Mailing Address
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Address Line | PO BOX 1613
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City | PINE BUSH
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State | NY
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Zip | 12566-1613
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Country | US
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Telephone | 845-545-6212
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Fax | 845-345-6212
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ERICKA MARIA VALENZUELA
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Credential | DO
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Telephone | 845-545-6212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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