Provider Demographics
NPI:1134521099
Name:VALENTINE, ZARIA (LAC)
Entity type:Individual
Prefix:
First Name:ZARIA
Middle Name:
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1533 JACKSON ST
Mailing Address - Street 2:APT 315
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-4464
Mailing Address - Country:US
Mailing Address - Phone:510-488-4664
Mailing Address - Fax:
Practice Address - Street 1:1533 JACKSON ST
Practice Address - Street 2:APT 315
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-4464
Practice Address - Country:US
Practice Address - Phone:510-488-4664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15949171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist