1750112801 NPI number — A VALENCIA NEUROLOGY PC

Table of content: (NPI 1750112801)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750112801 NPI number — A VALENCIA NEUROLOGY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A VALENCIA NEUROLOGY PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1750112801
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11016 DESERT DOVE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89144-1451
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:
2901 N TENAYA WAY STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89128-1404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-636-0193
Provider Business Practice Location Address Fax Number:
725-307-8716
Provider Enumeration Date:
08/12/2024

Additional Information

Authorized Official

Authorized Official Last Name:
VALENCIA
Authorized Official First Name:
ARLYN
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
702-235-5778

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1841205523 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com