Provider Demographics
NPI:1023296589
Name:VALENZUELA, LEI M (PHN)
Entity type:Individual
Prefix:MRS
First Name:LEI
Middle Name:M
Last Name:VALENZUELA
Suffix:
Gender:F
Credentials:PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 FERGUSON DR
Mailing Address - Street 2:SUITE 210-4
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90022-5164
Mailing Address - Country:US
Mailing Address - Phone:323-869-8231
Mailing Address - Fax:323-869-8230
Practice Address - Street 1:5555 FERGUSON DR
Practice Address - Street 2:SUITE 210-4
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90022-5164
Practice Address - Country:US
Practice Address - Phone:323-869-8231
Practice Address - Fax:323-869-8230
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA484555163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management