MEDICARE: MRS. JENNIFER MARIE VALDES P.T.

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	225100000X	Physical Therapist	PT27874	CA

General Provider Information

NPI Number	:	1205855921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER MARIE VALDES P.T.

Provider Business Mailing Address
First Line	:	PO BOX 811386
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90081
Country	:	US
Telephone Number	:	909-997-3134
Fax Number	:	909-494-4326

Provider Business Practice Location Address
First Line	:	1400 QUAIL ST
Second Line	:	UNIT 110
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92662
Country	:	US
Telephone Number	:	909-997-3134
Fax Number	:	909-494-4326

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	11/07/2018

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