Provider Demographics
NPI:1427356377
Name:VALENCIA, KRISTIAN HONTIVEROS
Entity Type:Individual
Prefix:
First Name:KRISTIAN
Middle Name:HONTIVEROS
Last Name:VALENCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3475 N SARATOGA ST
Mailing Address - Street 2:BLDG 993
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98278-8800
Mailing Address - Country:US
Mailing Address - Phone:360-257-9501
Mailing Address - Fax:360-257-9878
Practice Address - Street 1:3475 N SARATOGA ST
Practice Address - Street 2:BLDG 993
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98278-8800
Practice Address - Country:US
Practice Address - Phone:360-257-9501
Practice Address - Fax:360-257-9878
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman