MEDICARE: MIJA VALDEZ HHA, CMT

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	225700000X	Massage Therapist	21510	CA

General Provider Information

NPI Number	:	1376097584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIJA VALDEZ HHA, CMT

Provider Business Mailing Address
First Line	:	1440 LINCOLN AVE APT 28
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-2629
Country	:	US
Telephone Number	:	858-522-9277
Fax Number	:

Provider Business Practice Location Address
First Line	:	5252 BALBOA AVE STE 701
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-6930
Country	:	US
Telephone Number	:	858-522-9277
Fax Number	:

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

Provider Enumeration Date	:	08/05/2016
Last Update Date	:	08/05/2016

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