MEDICARE: DIANA VALENCIA

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	363LF0000X	Family Nurse Practitioner	255369	AZ
2	163WG0000X	General Practice Registered Nurse	RN170629	AZ

General Provider Information

NPI Number	:	1417554338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA VALENCIA

Provider Business Mailing Address
First Line	:	4801 E BROADWAY BLVD STE 251
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-2700
Country	:	US
Telephone Number	:	520-327-0460
Fax Number	:	520-795-0225

Provider Business Practice Location Address
First Line	:	1631 W INA RD STE 151
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-1907
Country	:	US
Telephone Number	:	520-585-5738
Fax Number	:

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

Provider Enumeration Date	:	10/04/2020
Last Update Date	:	06/23/2026

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Directions to “ DIANA VALENCIA ” Practice Location

Language	Start Address	Practice Location

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