MEDICARE: MICHAEL 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
1	1041C0700X	Clinical Social Worker	LCS14555	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LCS14555	OTHER	CA	LICENSE

General Provider Information

NPI Number	:	1194873810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL VALENZUELA

Provider Business Mailing Address
First Line	:	1501 W HENLEY CREEK RD
Second Line	:
City	:	REEDLEY
State	:	CA
Zip	:	93654-3621
Country	:	US
Telephone Number	:	559-638-2144
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 ACADEMY AVE
Second Line	:
City	:	SANGER
State	:	CA
Zip	:	93657-2128
Country	:	US
Telephone Number	:	559-875-7705
Fax Number	:	559-875-0142

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/09/2007

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Directions to “ MICHAEL VALENZUELA ” Practice Location

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