Provider Demographics
NPI:1558644146
Name:VALENCIA, HORTENCIA (CMT)
Entity type:Individual
Prefix:
First Name:HORTENCIA
Middle Name:
Last Name:VALENCIA
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12820 ORR AND DAY RD
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-2706
Mailing Address - Country:US
Mailing Address - Phone:310-633-0736
Mailing Address - Fax:
Practice Address - Street 1:30245 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-3603
Practice Address - Country:US
Practice Address - Phone:310-457-8396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1693225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist