Provider Demographics
NPI:1669293197
Name:VALENZUELA, ALEXANDER JARROD (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:JARROD
Last Name:VALENZUELA
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15010 FIR ST
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-4316
Mailing Address - Country:US
Mailing Address - Phone:760-669-5297
Mailing Address - Fax:
Practice Address - Street 1:15010 FIR ST
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-4316
Practice Address - Country:US
Practice Address - Phone:760-669-5297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95094788363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health