Provider Demographics
NPI:1457340713
Name:VALENCIA, JESSE MANUEL (PT,DC)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:MANUEL
Last Name:VALENCIA
Suffix:
Gender:M
Credentials:PT,DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-5138
Mailing Address - Country:US
Mailing Address - Phone:562-434-0062
Mailing Address - Fax:562-439-4617
Practice Address - Street 1:3535 E 7TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-5138
Practice Address - Country:US
Practice Address - Phone:562-434-0062
Practice Address - Fax:562-439-4617
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16918111N00000X
CAPT8264225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT8264Medicare PIN
CADC16918Medicare PIN