Provider Demographics
NPI:1780040964
Name:VALERA, QUOZETTE SAN MIGUEL (DPT)
Entity Type:Individual
Prefix:
First Name:QUOZETTE
Middle Name:SAN MIGUEL
Last Name:VALERA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4482 BARRANCA PKWY STE 195
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4706
Mailing Address - Country:US
Mailing Address - Phone:949-679-3337
Mailing Address - Fax:949-679-3336
Practice Address - Street 1:2820 N BELLFLOWER BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-1125
Practice Address - Country:US
Practice Address - Phone:562-384-4525
Practice Address - Fax:562-384-4524
Is Sole Proprietor?:No
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43517225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist