Provider Demographics
NPI:1841054210
Name:VALENZUELA, LINDA M
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:VALENZUELA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 N 14TH ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:OK
Mailing Address - Zip Code:73542-1405
Mailing Address - Country:US
Mailing Address - Phone:580-418-7221
Mailing Address - Fax:
Practice Address - Street 1:1619 N 14TH ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:OK
Practice Address - Zip Code:73542-1405
Practice Address - Country:US
Practice Address - Phone:580-418-7221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-07
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist