1942853668 NPI number — ALFRED R. VALENZUELA, D.C., INC.

Table of content: (NPI 1942853668)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942853668 NPI number — ALFRED R. VALENZUELA, D.C., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALFRED R. VALENZUELA, D.C., INC.
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:
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:
1942853668
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75-167 KALANI ST STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KAILUA KONA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96740-1800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-326-9355
Provider Business Mailing Address Fax Number:
808-326-1997

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75-167 KALANI ST STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAILUA KONA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96740-1800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-326-9355
Provider Business Practice Location Address Fax Number:
808-326-1997
Provider Enumeration Date:
07/22/2019

Additional Information

Authorized Official

Authorized Official Last Name:
VALENZUELA
Authorized Official First Name:
ALFRED
Authorized Official Middle Name:
RICHAD
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
808-747-1644

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1467585042 . This is a "OLD NPI NUMBER" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 374 . This is a "DO NOT HAVE ANY OTHER NUMBER OTHER THAN NPI" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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