1730544990 NPI number — MRS. GRELDA ITZELA VALENCIA CHAVEZ D.D.S.

Table of content: MRS. GRELDA ITZELA VALENCIA CHAVEZ D.D.S. (NPI 1730544990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730544990 NPI number — MRS. GRELDA ITZELA VALENCIA CHAVEZ D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VALENCIA CHAVEZ
Provider First Name:
GRELDA
Provider Middle Name:
ITZELA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
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:
1730544990
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4364 BONITA RD #233
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BONITA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91902-1421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE ANTONIO CASO #2055-603, ZONA RIO
Provider Second Line Business Practice Location Address:
TIJUANA
Provider Business Practice Location Address City Name:
MEXICO
Provider Business Practice Location Address State Name:
BAJA CALIFORNIA
Provider Business Practice Location Address Postal Code:
22010
Provider Business Practice Location Address Country Code:
MX
Provider Business Practice Location Address Telephone Number:
011526649729420
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/15/2015

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: 122300000X , with the licence number:  1859111 , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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