Provider Demographics
NPI:1770289175
Name:VALENZUELA, EMILIA GUADALUPE (LMT)
Entity type:Individual
Prefix:
First Name:EMILIA
Middle Name:GUADALUPE
Last Name:VALENZUELA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:EMILIA
Other - Middle Name:G
Other - Last Name:VALENZUELA-SHERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:944 MICAHS WAY N
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390-6000
Mailing Address - Country:US
Mailing Address - Phone:520-473-9512
Mailing Address - Fax:
Practice Address - Street 1:944 MICAHS WAY N
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NC
Practice Address - Zip Code:28390-6000
Practice Address - Country:US
Practice Address - Phone:520-473-9512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-19450225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist