Provider Demographics
NPI:1073021143
Name:VALENTIN-FUENTES, YAMIRA (DC)
Entity Type:Individual
Prefix:DR
First Name:YAMIRA
Middle Name:
Last Name:VALENTIN-FUENTES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 WESTGATE MALL DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301
Mailing Address - Country:US
Mailing Address - Phone:864-359-9421
Mailing Address - Fax:864-886-2502
Practice Address - Street 1:210 WESTGATE MALL DR
Practice Address - Street 2:SUITE 6
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301
Practice Address - Country:US
Practice Address - Phone:864-359-9421
Practice Address - Fax:864-886-2502
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-11
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4282111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty