Provider Demographics
NPI:1811484637
Name:VALDIVIA, ELIZABETH (RDHAP)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:VALDIVIA
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:GUILLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:455 E COLUMBIA ST # 32
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1620
Mailing Address - Country:US
Mailing Address - Phone:562-933-3141
Mailing Address - Fax:562-933-2049
Practice Address - Street 1:455 E COLUMBIA ST # 32
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1620
Practice Address - Country:US
Practice Address - Phone:562-933-3141
Practice Address - Fax:562-933-2049
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA683124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist