Provider Demographics
NPI:1750062204
Name:VALENZO, HEIDI M
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:M
Last Name:VALENZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 4TH ST
Mailing Address - Street 2:
Mailing Address - City:TAFT
Mailing Address - State:CA
Mailing Address - Zip Code:93268-2433
Mailing Address - Country:US
Mailing Address - Phone:661-745-0001
Mailing Address - Fax:
Practice Address - Street 1:1021 4TH ST
Practice Address - Street 2:
Practice Address - City:TAFT
Practice Address - State:CA
Practice Address - Zip Code:93268-2433
Practice Address - Country:US
Practice Address - Phone:661-745-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPSS-PXBJTY175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist