Provider Demographics
NPI:1134702087
Name:VALENZUELA, JULISSA DENISE
Entity Type:Individual
Prefix:
First Name:JULISSA
Middle Name:DENISE
Last Name:VALENZUELA
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 1:10121 VALLEY VIEW ST
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-4602
Mailing Address - Country:US
Mailing Address - Phone:714-252-4122
Mailing Address - Fax:174-252-7171
Practice Address - Street 1:10121 VALLEY VIEW ST
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-4602
Practice Address - Country:US
Practice Address - Phone:714-252-4122
Practice Address - Fax:714-252-7171
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8650237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist