Provider Demographics
NPI:1356525901
Name:VALLEY PRACTITIONERS PS
Entity type:Organization
Organization Name:VALLEY PRACTITIONERS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CIPRIANO
Authorized Official - Middle Name:C
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:509-830-4643
Mailing Address - Street 1:PO BOX 684
Mailing Address - Street 2:
Mailing Address - City:TOPPENISH
Mailing Address - State:WA
Mailing Address - Zip Code:98948-0684
Mailing Address - Country:US
Mailing Address - Phone:509-830-4643
Mailing Address - Fax:509-865-2682
Practice Address - Street 1:419 N D ST
Practice Address - Street 2:
Practice Address - City:TOPPENISH
Practice Address - State:WA
Practice Address - Zip Code:98948-1201
Practice Address - Country:US
Practice Address - Phone:509-830-4643
Practice Address - Fax:509-865-2682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9626318Medicaid