Provider Demographics
NPI:1538492848
Name:VALENZUELA, ERIKA L (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:L
Last Name:VALENZUELA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-6866
Mailing Address - Country:US
Mailing Address - Phone:413-443-6116
Mailing Address - Fax:413-443-9099
Practice Address - Street 1:195 SOUTH ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-6866
Practice Address - Country:US
Practice Address - Phone:413-443-6116
Practice Address - Fax:413-443-9099
Is Sole Proprietor?:No
Enumeration Date:2009-09-18
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0018041Medicare PIN