1295851582 NPI number — MS. VALENCIA MENYAN VANNER FAODP

Table of content: MS. VALENCIA MENYAN VANNER FAODP (NPI 1295851582)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295851582 NPI number — MS. VALENCIA MENYAN VANNER FAODP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANNER
Provider First Name:
VALENCIA
Provider Middle Name:
MENYAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
FAODP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295851582
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1104 AMOS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PONTIAC
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48342-1802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-499-6132
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
196 CESAR E CHAVEZ AVE
Provider Second Line Business Practice Location Address:
SUITE B-201
Provider Business Practice Location Address City Name:
PONTIAC
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48342-1094
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-253-0176
Provider Business Practice Location Address Fax Number:
248-253-1570
Provider Enumeration Date:
03/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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