Provider Demographics
NPI:1528236619
Name:VALDECANAS, CHRISTIAN ROAN ALONZO (RPT)
Entity type:Individual
Prefix:MR
First Name:CHRISTIAN ROAN
Middle Name:ALONZO
Last Name:VALDECANAS
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2692 PIKAKE ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-4267
Mailing Address - Country:US
Mailing Address - Phone:619-274-3559
Mailing Address - Fax:
Practice Address - Street 1:2692 PIKAKE ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-4267
Practice Address - Country:US
Practice Address - Phone:619-274-3559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.015187225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist