Provider Demographics
NPI:1457760019
Name:VALENZUELA, IRENE DENISE (NP)
Entity Type:Individual
Prefix:MS
First Name:IRENE
Middle Name:DENISE
Last Name:VALENZUELA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1772
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91785-1772
Mailing Address - Country:US
Mailing Address - Phone:909-652-2933
Mailing Address - Fax:909-949-9302
Practice Address - Street 1:1377 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-5047
Practice Address - Country:US
Practice Address - Phone:909-652-2933
Practice Address - Fax:909-949-9302
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14480363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily