Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1013590413 |
---|---|
Provider Name | Michael Valenzuela |
First Address | La Puente, CA 91744-5532 |
Second Address | Santa Fe Springs, CA 90670-3674 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2021 |
Last Update Date | 03/05/2021 |