Provider Demographics
NPI:1942961636
Name:VALTIERRA, MARY C
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:VALTIERRA
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 1:691 S EL PRADO RD
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-2555
Mailing Address - Country:US
Mailing Address - Phone:928-502-1411
Mailing Address - Fax:
Practice Address - Street 1:691 S EL PRADO RD
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-2555
Practice Address - Country:US
Practice Address - Phone:928-502-1411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-04
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty