Provider Demographics
NPI:1275112476
Name:VALDIVIA, VANESSA (DO)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:VALDIVIA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 HELEN DR APT 107
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-1676
Mailing Address - Country:US
Mailing Address - Phone:561-876-6395
Mailing Address - Fax:
Practice Address - Street 1:700 MULLICA HILL RD
Practice Address - Street 2:
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062-4413
Practice Address - Country:US
Practice Address - Phone:856-508-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2022-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program