Provider Demographics
NPI:1093586604
Name:VALENCIA, DIANA IBARRA
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:IBARRA
Last Name:VALENCIA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 TELEGRAPH AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2031
Mailing Address - Country:US
Mailing Address - Phone:415-404-3168
Mailing Address - Fax:
Practice Address - Street 1:2920 TELEGRAPH AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2031
Practice Address - Country:US
Practice Address - Phone:415-404-3168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2025-03-08
Deactivation Date:2024-10-23
Deactivation Code:
Reactivation Date:2025-03-07
Provider Licenses
StateLicense IDTaxonomies
CA95055572163W00000X
CA95032713363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse