=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740166909
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUAN SEBASTIAN VALENCIA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2025
-----------------------------------------------------
Last Update Date | 12/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 589 NW 11TH ST
-----------------------------------------------------
City | HERMISTON
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97838-6600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-567-1717
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 190
-----------------------------------------------------
City | TOPPENISH
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98948-0190
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-865-2395
-----------------------------------------------------
Fax | 509-865-0757
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA228322
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------