Provider Demographics
NPI:1114009107
Name:VALENCIA, RAINILDA PINGA (MD)
Entity Type:Individual
Prefix:MRS
First Name:RAINILDA
Middle Name:PINGA
Last Name:VALENCIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12677 HESPERIA RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-7735
Mailing Address - Country:US
Mailing Address - Phone:760-955-5656
Mailing Address - Fax:760-955-6176
Practice Address - Street 1:12677 HESPERIA RD
Practice Address - Street 2:SUITE 160
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-7735
Practice Address - Country:US
Practice Address - Phone:760-955-5656
Practice Address - Fax:760-955-6176
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53787208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A537870Medicaid