Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1101X | Ophthalmic Assistant |
NPI | 1679120968 |
---|---|
Provider Name | Evelyn Valenzuela |
First Address | Phoenix, AZ 85016-4701 |
Second Address | Phoenix, AZ 85016-4701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2019 |
Last Update Date | 21/08/2019 |