Provider Demographics
NPI:1376621946
Name:VALENZUELA, ANGELICA FAYE (PT)
Entity Type:Individual
Prefix:
First Name:ANGELICA FAYE
Middle Name:
Last Name:VALENZUELA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 HICKEY BLVD
Mailing Address - Street 2:STE. 205
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2629
Mailing Address - Country:US
Mailing Address - Phone:650-746-3299
Mailing Address - Fax:650-994-1359
Practice Address - Street 1:455 HICKEY BLVD
Practice Address - Street 2:STE. 205
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2629
Practice Address - Country:US
Practice Address - Phone:650-746-3299
Practice Address - Fax:650-994-1359
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT30348225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist