Provider Demographics
NPI:1235374513
Name:VALBUENA, PRISCILLA M (RN)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:M
Last Name:VALBUENA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15082 GLASS CIR
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-2918
Mailing Address - Country:US
Mailing Address - Phone:949-310-2953
Mailing Address - Fax:916-929-1531
Practice Address - Street 1:3230 PEACEKEEPER WAY
Practice Address - Street 2:CBWTU-CA
Practice Address - City:MCCLELLAN PARK
Practice Address - State:CA
Practice Address - Zip Code:95652
Practice Address - Country:US
Practice Address - Phone:916-830-1517
Practice Address - Fax:916-929-1531
Is Sole Proprietor?:No
Enumeration Date:2008-12-15
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA553087163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse