Provider Demographics
NPI:1780891994
Name:VALENCIA, LEOPOLDO CANON
Entity type:Individual
Prefix:
First Name:LEOPOLDO
Middle Name:CANON
Last Name:VALENCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4228 77TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820-3627
Mailing Address - Country:US
Mailing Address - Phone:916-457-2260
Mailing Address - Fax:916-457-2260
Practice Address - Street 1:4228 77TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-3627
Practice Address - Country:US
Practice Address - Phone:916-457-2260
Practice Address - Fax:916-457-2260
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)