MEDICARE: LYNNETTE ELEONORA 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	183500000X	Pharmacist	91815	CA

General Provider Information

NPI Number	:	1942165188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNNETTE ELEONORA VALENCIA

Provider Business Mailing Address
First Line	:	400 S KINGSLEY DR APT 212
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-3223
Country	:	US
Telephone Number	:	909-223-3853
Fax Number	:

Provider Business Practice Location Address
First Line	:	747 GRAND AVE
Second Line	:
City	:	DIAMOND BAR
State	:	CA
Zip	:	91765-8400
Country	:	US
Telephone Number	:	909-610-2150
Fax Number	:	909-610-2114

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

Provider Enumeration Date	:	12/19/2025
Last Update Date	:	12/19/2025

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