Provider Demographics
NPI:1316605447
Name:LAURENTE, WILSON VALDEZ (LVN)
Entity type:Individual
Prefix:
First Name:WILSON
Middle Name:VALDEZ
Last Name:LAURENTE
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2158 SOLANO WAY
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-4700
Mailing Address - Country:US
Mailing Address - Phone:510-499-7935
Mailing Address - Fax:
Practice Address - Street 1:2158 SOLANO WAY
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-4700
Practice Address - Country:US
Practice Address - Phone:510-499-7935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN251766164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse