Provider Demographics
NPI:1285903989
Name:VALENCIA, JELA Q
Entity type:Individual
Prefix:DR
First Name:JELA
Middle Name:Q
Last Name:VALENCIA
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 1:1169 N MILITARY HWY
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-2434
Mailing Address - Country:US
Mailing Address - Phone:757-466-7036
Mailing Address - Fax:757-466-7103
Practice Address - Street 1:1169 N MILITARY HWY
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-2434
Practice Address - Country:US
Practice Address - Phone:757-466-7036
Practice Address - Fax:757-466-7103
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-26
Last Update Date:2011-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202209332183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist