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General NPI Number Information
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NPI Number | 1720520463
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Entity Type | Individual
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Provider Name | VALERIE TISONE
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Gender | Female
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Dates
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Enumeration Date | 11/11/2016
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Last Update Date | 11/11/2016
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Provider Practice Location Address
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Address Line | 1988 FREEDOM BLVD
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City | FREEDOM
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State | CA
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Zip | 95019-2837
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Country | US
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Telephone | 831-724-5104
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Fax |
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Provider Business Mailing Address
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Address Line | 2602 N RODEO GULCH RD
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City | SOQUEL
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State | CA
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Zip | 95073-9713
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Country | US
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Telephone | 831-462-3592
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 42201
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License Number State | CA
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