Provider Demographics
NPI:1912683921
Name:VALENCIA, EL NINA (PT)
Entity Type:Individual
Prefix:
First Name:EL NINA
Middle Name:
Last Name:VALENCIA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5531 JUNCTION BLVD APT 1
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5210
Mailing Address - Country:US
Mailing Address - Phone:408-209-5476
Mailing Address - Fax:
Practice Address - Street 1:49 W 24TH ST FL 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-3570
Practice Address - Country:US
Practice Address - Phone:917-694-1565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04722501225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist