Provider Demographics
NPI:1417905134
Name:VALKOV, NATHALIE (LAC)
Entity Type:Individual
Prefix:
First Name:NATHALIE
Middle Name:
Last Name:VALKOV
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 W GLENOAKS BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-1978
Mailing Address - Country:US
Mailing Address - Phone:818-230-2419
Mailing Address - Fax:818-230-2426
Practice Address - Street 1:1314 W GLENOAKS BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-1978
Practice Address - Country:US
Practice Address - Phone:818-230-2419
Practice Address - Fax:818-230-2426
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10571171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist