Provider Demographics
NPI:1104210483
Name:VALENCIA DERAY, KRISTEN
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:
Last Name:VALENCIA DERAY
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 1:1102 BATES AVE STE 1120
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2698
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:614-722-6132
Practice Address - Street 1:1102 BATES AVE STE 1120
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2698
Practice Address - Country:US
Practice Address - Phone:832-824-1780
Practice Address - Fax:614-722-6132
Is Sole Proprietor?:No
Enumeration Date:2015-03-24
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXT06562080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program