Provider Demographics
NPI:1134307796
Name:VALENCIA, ROSALINO CRUZ (LADC)
Entity Type:Individual
Prefix:
First Name:ROSALINO
Middle Name:CRUZ
Last Name:VALENCIA
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 PLEASANT AVE SOUTH
Mailing Address - Street 2:CREATE INC
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403
Mailing Address - Country:US
Mailing Address - Phone:612-874-9811
Mailing Address - Fax:612-874-9820
Practice Address - Street 1:1911 PLEASANT AVE SOUTH
Practice Address - Street 2:CREATE INC
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403
Practice Address - Country:US
Practice Address - Phone:612-874-9811
Practice Address - Fax:612-874-9820
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN300664101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN300664OtherLADC