Provider Demographics
NPI:1841803269
Name:VALDIVIA, MAYRA A
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:A
Last Name:VALDIVIA
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 1:26701 QUAIL CRK APT 280
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3062
Mailing Address - Country:US
Mailing Address - Phone:949-295-1969
Mailing Address - Fax:
Practice Address - Street 1:26701 QUAIL CRK APT 280
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92656-3062
Practice Address - Country:US
Practice Address - Phone:949-295-1969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty