Provider Demographics
NPI:1356898803
Name:VALADEZ, JACQUELYN ADRIANA
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:ADRIANA
Last Name:VALADEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 N. GRAPE STREET
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4435
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:490 N. GRAPE STREET
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4435
Practice Address - Country:US
Practice Address - Phone:760-975-9939
Practice Address - Fax:760-509-9093
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA685505164X00000X
CA95409343163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse