Provider Demographics
NPI:1225775372
Name:VALENZUELA, JOHN MELVIN WONG (NP-C)
Entity Type:Individual
Prefix:MR
First Name:JOHN MELVIN
Middle Name:WONG
Last Name:VALENZUELA
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 W STEWART DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3849
Mailing Address - Country:US
Mailing Address - Phone:714-633-9111
Mailing Address - Fax:626-667-8781
Practice Address - Street 1:1100 W STEWART DR
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3849
Practice Address - Country:US
Practice Address - Phone:714-633-9111
Practice Address - Fax:626-667-8781
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-18
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95020509363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty