Provider Demographics
NPI:1003663303
Name:VALDEZ, CYNTHIA NICOLE
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:NICOLE
Last Name:VALDEZ
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 1:33336 AGUA DULCE CANYON RD STE 107
Mailing Address - Street 2:
Mailing Address - City:AGUA DULCE
Mailing Address - State:CA
Mailing Address - Zip Code:91390-3484
Mailing Address - Country:US
Mailing Address - Phone:818-272-3159
Mailing Address - Fax:
Practice Address - Street 1:33336 AGUA DULCE CANYON RD STE 107
Practice Address - Street 2:
Practice Address - City:AGUA DULCE
Practice Address - State:CA
Practice Address - Zip Code:91390-3484
Practice Address - Country:US
Practice Address - Phone:818-272-3159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48054225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist