Provider Demographics
NPI:1245835453
Name:VALENCIA, JUNER (BSN, RN, PHN)
Entity type:Individual
Prefix:
First Name:JUNER
Middle Name:
Last Name:VALENCIA
Suffix:
Gender:M
Credentials:BSN, RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 VIDELL ST
Mailing Address - Street 2:
Mailing Address - City:SAN LORENZO
Mailing Address - State:CA
Mailing Address - Zip Code:94580-1142
Mailing Address - Country:US
Mailing Address - Phone:510-329-3535
Mailing Address - Fax:
Practice Address - Street 1:723 VIDELL ST
Practice Address - Street 2:
Practice Address - City:SAN LORENZO
Practice Address - State:CA
Practice Address - Zip Code:94580-1142
Practice Address - Country:US
Practice Address - Phone:510-329-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA773832163W00000X, 163WP0808X, 163WE0003X
CA77893163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health