Provider Demographics
NPI:1295745958
Name:VALENZUELA, ADELA MERCEDES (CERTIFIED WON)
Entity type:Individual
Prefix:MRS
First Name:ADELA
Middle Name:MERCEDES
Last Name:VALENZUELA
Suffix:
Gender:F
Credentials:CERTIFIED WON
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15010 FIR STREET
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-4316
Mailing Address - Country:US
Mailing Address - Phone:760-488-1209
Mailing Address - Fax:
Practice Address - Street 1:12021 JACARANDA AVE
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-4978
Practice Address - Country:US
Practice Address - Phone:760-956-5334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA430539163WE0900X
CA19668363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0900XNursing Service ProvidersRegistered NurseEnterostomal Therapy