MEDICARE: TASHA N 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	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1417613399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TASHA N VALENCIA

Provider Business Mailing Address
First Line	:	8116 JOHN ROBERT DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73135-6043
Country	:	US
Telephone Number	:	405-913-9656
Fax Number	:

Provider Business Practice Location Address
First Line	:	8116 JOHN ROBERT DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73135-6043
Country	:	US
Telephone Number	:	405-913-9656
Fax Number	:

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

Provider Enumeration Date	:	11/15/2021
Last Update Date	:	11/15/2021

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Directions to “ TASHA N VALENCIA ” Practice Location

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