Provider Demographics
NPI:1194356683
Name:AMEZQUITA, VALERIE V
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:V
Last Name:AMEZQUITA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:V
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:161 N DATE ST
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3405
Mailing Address - Country:US
Mailing Address - Phone:760-745-7786
Mailing Address - Fax:760-745-1061
Practice Address - Street 1:161 N DATE ST
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3405
Practice Address - Country:US
Practice Address - Phone:760-745-7786
Practice Address - Fax:760-745-1061
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA269401164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse