MEDICARE: EVANGELINA VALDIVIA

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	2355S0801X	Speech-Language Assistant	SLPA9604	AZ

General Provider Information

NPI Number	:	1952858508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVANGELINA VALDIVIA

Provider Business Mailing Address
First Line	:	1028 NTH 60TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85043-1504
Country	:	US
Telephone Number	:	602-326-2063
Fax Number	:

Provider Business Practice Location Address
First Line	:	6500 S 35TH AVE APT 28
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-5058
Country	:	US
Telephone Number	:	602-326-2063
Fax Number	:

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

Provider Enumeration Date	:	09/01/2016
Last Update Date	:	02/13/2026

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Directions to “ EVANGELINA VALDIVIA ” Practice Location

Language	Start Address	Practice Location

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