MEDICARE: MRS. SHARON ANN VALIENZI RDH

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	124Q00000X	Dental Hygienist	9414	CA

General Provider Information

NPI Number	:	1962616938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHARON ANN VALIENZI RDH

Provider Business Mailing Address
First Line	:	456 AVENIDA DE DIAMANTE
Second Line	:
City	:	ARROYO GRANDE
State	:	CA
Zip	:	93420-1937
Country	:	US
Telephone Number	:	805-489-8444
Fax Number	:

Provider Business Practice Location Address
First Line	:	1558 W GRAND AVE
Second Line	:
City	:	GROVER BEACH
State	:	CA
Zip	:	93433-2236
Country	:	US
Telephone Number	:	805-489-8444
Fax Number	:	805-489-4783

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

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	07/08/2007

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