MEDICARE: VALERIE MARIE PABLOS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	LP048500	AZ

General Provider Information

NPI Number	:	1043632474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIE MARIE PABLOS

Provider Business Mailing Address
First Line	:	8209 S 24TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-7001
Country	:	US
Telephone Number	:	602-465-2869
Fax Number	:

Provider Business Practice Location Address
First Line	:	8209 S 24TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-7001
Country	:	US
Telephone Number	:	602-465-2869
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2014
Last Update Date	:	01/21/2014

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Directions to “ VALERIE MARIE PABLOS ” Practice Location

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