Provider Demographics
NPI:1831239862
Name:VALERIANO, VICENTE (L AC ,DOM)
Entity type:Individual
Prefix:
First Name:VICENTE
Middle Name:
Last Name:VALERIANO
Suffix:
Gender:M
Credentials:L AC ,DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7610 IROQUOIS ST
Mailing Address - Street 2:
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-9604
Mailing Address - Country:US
Mailing Address - Phone:763-350-1019
Mailing Address - Fax:
Practice Address - Street 1:14030 23RD AVE N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-4773
Practice Address - Country:US
Practice Address - Phone:763-350-1019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1289171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist