Provider Demographics
NPI:1194453860
Name:VALENCIA, JOSE N (PT, DPT)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:N
Last Name:VALENCIA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BANAGAS CT
Mailing Address - Street 2:
Mailing Address - City:CALEXICO
Mailing Address - State:CA
Mailing Address - Zip Code:92231-1743
Mailing Address - Country:US
Mailing Address - Phone:760-562-1895
Mailing Address - Fax:
Practice Address - Street 1:2536 ROCKWOOD AVE STE 102
Practice Address - Street 2:
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-4408
Practice Address - Country:US
Practice Address - Phone:760-768-3422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA302507225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist