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NPI Code Detail

MEDICARE: MR. VINCENT RAY VALENZUELA

MEDICARE: MR. VINCENT RAY VALENZUELA
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
1101Y00000XCounselor

General Provider Information

NPI Number : 1194859678
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. VINCENT RAY VALENZUELA
Provider Business Mailing Address
First Line : 4530 WINDSONG ST
Second Line :
City : SACRAMENTO
State : CA
Zip : 95834-2511
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4530 WINDSONG ST
Second Line :
City : SACRAMENTO
State : CA
Zip : 95834-2511
Country : US
Telephone Number : 916-388-6369
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2007
Last Update Date : 07/08/2007

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Directions to “ MR. VINCENT RAY VALENZUELA ” Practice Location

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