Provider Demographics
NPI:1053079475
Name:VALENZUELA CAMPOS, LORENA
Entity Type:Individual
Prefix:
First Name:LORENA
Middle Name:
Last Name:VALENZUELA CAMPOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2039 L AVE APT 11
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-5943
Mailing Address - Country:US
Mailing Address - Phone:619-288-7733
Mailing Address - Fax:
Practice Address - Street 1:1750 AVENIDA DEL MUNDO UNIT 302
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-3093
Practice Address - Country:US
Practice Address - Phone:619-435-2355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider