Provider Demographics
NPI:1619502408
Name:OJEDA IRIZARRY, VALERIA NICOLE (DC)
Entity Type:Individual
Prefix:
First Name:VALERIA
Middle Name:NICOLE
Last Name:OJEDA IRIZARRY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 AVE GENERAL VALERO STE 406
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-3992
Mailing Address - Country:US
Mailing Address - Phone:787-655-0101
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA #2 KM 16.17 BO. CANDELARIA
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:939-945-8036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-11
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR722111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor