Provider Demographics
NPI:1164777850
Name:VALDIVIA, ROSA
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:VALDIVIA
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 1:703 MIDDLEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HERKIMER
Mailing Address - State:NY
Mailing Address - Zip Code:13350-0107
Mailing Address - Country:US
Mailing Address - Phone:315-866-7932
Mailing Address - Fax:315-866-1914
Practice Address - Street 1:703 MIDDLEVILLE RD RT 28
Practice Address - Street 2:
Practice Address - City:HERKIMER
Practice Address - State:NY
Practice Address - Zip Code:13350-0107
Practice Address - Country:US
Practice Address - Phone:315-866-7932
Practice Address - Fax:315-866-1914
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY265682-1374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide