Provider Demographics
NPI:1295314524
Name:VALENCIA, MARIA (PT)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:VALENCIA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:GORETTI
Other - Last Name:AFRICA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:845 S KINGSLEY DR APT 105
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-4361
Mailing Address - Country:US
Mailing Address - Phone:323-404-5528
Mailing Address - Fax:
Practice Address - Street 1:6826 S CENTINELA AVE
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6301
Practice Address - Country:US
Practice Address - Phone:310-915-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299905225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist