Provider Demographics
NPI:1811772049
Name:VALENZUELA SILVA, IVAN (NASM-PES, KT, AT)
Entity type:Individual
Prefix:
First Name:IVAN
Middle Name:
Last Name:VALENZUELA SILVA
Suffix:
Gender:M
Credentials:NASM-PES, KT, AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 E BROCKTON AVE
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-3611
Mailing Address - Country:US
Mailing Address - Phone:909-283-1830
Mailing Address - Fax:909-328-1827
Practice Address - Street 1:1030 E BROCKTON AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-3611
Practice Address - Country:US
Practice Address - Phone:909-283-1830
Practice Address - Fax:909-328-1827
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist