Provider Demographics
NPI:1821664327
Name:VALENZUELA FIGUEROA, ILLIANNA
Entity Type:Individual
Prefix:
First Name:ILLIANNA
Middle Name:
Last Name:VALENZUELA FIGUEROA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 LAKE MARY RD APT 331
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86005-9250
Mailing Address - Country:US
Mailing Address - Phone:520-612-3429
Mailing Address - Fax:
Practice Address - Street 1:3601 LAKE MARY RD APT 331
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86005-9250
Practice Address - Country:US
Practice Address - Phone:520-612-3429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program