Provider Demographics
NPI:1871190496
Name:VALENCIA BLANCAS, IVONNE GUADALUPE
Entity Type:Individual
Prefix:MRS
First Name:IVONNE
Middle Name:GUADALUPE
Last Name:VALENCIA BLANCAS
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 1:7B LUKE DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-2608
Mailing Address - Country:US
Mailing Address - Phone:707-264-9150
Mailing Address - Fax:
Practice Address - Street 1:7B LUKE DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-2608
Practice Address - Country:US
Practice Address - Phone:707-264-9150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician