Provider Demographics
NPI:1689102600
Name:VALENZUELA, LLUVIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:LLUVIA
Middle Name:
Last Name:VALENZUELA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2585 S NELLIS BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-7548
Mailing Address - Country:US
Mailing Address - Phone:702-641-0481
Mailing Address - Fax:
Practice Address - Street 1:2585 S NELLIS BLVD STE 6
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-7548
Practice Address - Country:US
Practice Address - Phone:702-641-0481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-03
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6913122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty