Provider Demographics
NPI:1346379641
Name:VALTIERRA, KEVIN (RESPIRATORY TECH)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:VALTIERRA
Suffix:
Gender:M
Credentials:RESPIRATORY TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8978 BAINBRIDGE PL
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-4807
Mailing Address - Country:US
Mailing Address - Phone:209-470-6848
Mailing Address - Fax:209-474-1565
Practice Address - Street 1:8978 BAINBRIDGE PL
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-4807
Practice Address - Country:US
Practice Address - Phone:209-470-6848
Practice Address - Fax:209-474-1565
Is Sole Proprietor?:No
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00021401247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ27464ZMedicare ID - Type Unspecified