Provider Demographics
NPI:1215759683
Name:SIQUEIROS VALENZUELA, ESTEFANNY
Entity type:Individual
Prefix:
First Name:ESTEFANNY
Middle Name:
Last Name:SIQUEIROS 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 1:1435 E 36TH ST APT 9109
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85713-6342
Mailing Address - Country:US
Mailing Address - Phone:520-369-7232
Mailing Address - Fax:
Practice Address - Street 1:1435 E 36TH ST APT 9109
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-6342
Practice Address - Country:US
Practice Address - Phone:520-369-7232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29320225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist