Provider Demographics
NPI:1649266685
Name:VALENZUELA, LAURA JANE (NP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:JANE
Last Name:VALENZUELA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:JANE
Other - Last Name:WALTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:4000 PHYSICIAN'S BLVD
Mailing Address - Street 2:BUILDING E, SUITE 211
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301
Mailing Address - Country:US
Mailing Address - Phone:661-401-2000
Mailing Address - Fax:661-401-2015
Practice Address - Street 1:4000 PHYSICIAN'S BLVD
Practice Address - Street 2:BUILDING E, SUITE 211
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301
Practice Address - Country:US
Practice Address - Phone:661-401-2000
Practice Address - Fax:661-401-2015
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF10053363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ17201ZMedicare UPIN
CAZZZ172012Medicare UPIN