1649465105 NPI number — MS. THERESA JANE VALENZUELA L.AC.

Table of content: MS. THERESA JANE VALENZUELA L.AC. (NPI 1649465105)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649465105 NPI number — MS. THERESA JANE VALENZUELA L.AC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VALENZUELA
Provider First Name:
THERESA
Provider Middle Name:
JANE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
L.AC.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GRYBOSKY
Provider Other First Name:
THERESA
Provider Other Middle Name:
JANE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.AC.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649465105
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
445 W BELL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEQUIM
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98382-3758
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-477-4781
Provider Business Mailing Address Fax Number:
360-582-0999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
445 W BELL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEQUIM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98382-3758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-477-4781
Provider Business Practice Location Address Fax Number:
360-582-0999
Provider Enumeration Date:
09/07/2007

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: 171100000X , with the licence number:  AC00002476 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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