Provider Demographics
NPI:1487257457
Name:VALENZUELA, VANESSA ZULAY (HYGIENIST)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:ZULAY
Last Name:VALENZUELA
Suffix:
Gender:F
Credentials:HYGIENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2378 WHITE LILLY DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34747-1746
Mailing Address - Country:US
Mailing Address - Phone:954-668-0601
Mailing Address - Fax:
Practice Address - Street 1:2907 VINELAND RD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-5505
Practice Address - Country:US
Practice Address - Phone:407-397-1032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH25205124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist