MEDICARE: KELLY VICTORIA VALENZUELA PA-C

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1245015783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY VICTORIA VALENZUELA PA-C

Provider Business Mailing Address
First Line	:	1912 HAVEMEYER LN
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90278-4830
Country	:	US
Telephone Number	:	951-483-0618
Fax Number	:

Provider Business Practice Location Address
First Line	:	3490 LINDEN AVE STE 2
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-4559
Country	:	US
Telephone Number	:	888-368-1850
Fax Number	:

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

Provider Enumeration Date	:	08/30/2023
Last Update Date	:	11/06/2024

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Directions to “ KELLY VICTORIA VALENZUELA PA-C” Practice Location

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