Provider Demographics
NPI:1255007035
Name:VALENZUELA-OJEDA, IRIS J
Entity Type:Individual
Prefix:MISS
First Name:IRIS
Middle Name:J
Last Name:VALENZUELA-OJEDA
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:HE17 CALLE 221
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00982-2643
Mailing Address - Country:US
Mailing Address - Phone:787-223-2201
Mailing Address - Fax:
Practice Address - Street 1:#18 CALLE ILUSION
Practice Address - Street 2:VILLA CALIZ I
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727
Practice Address - Country:US
Practice Address - Phone:787-565-6009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR20655101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR22655OtherPROFESSIONAL LICENSE