Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 5007542 | NC |
NPI | 1003200619 |
---|---|
Provider Name | Mr. Orlando Santiago Valenzuela JR. |
First Address | Jamestown, NC 27282-7710 |
Second Address | Asheboro, NC 27203-5514 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2015 |
Last Update Date | 12/10/2021 |