Provider Demographics
NPI:1962555185
Name:VALENCIA, MARIE ANGELIE E
Entity type:Individual
Prefix:MRS
First Name:MARIE ANGELIE
Middle Name:E
Last Name:VALENCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-1128 HALELEHUA ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-3703
Mailing Address - Country:US
Mailing Address - Phone:808-680-7471
Mailing Address - Fax:808-680-7471
Practice Address - Street 1:94-1128 HALELEHUA ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3703
Practice Address - Country:US
Practice Address - Phone:808-680-7471
Practice Address - Fax:808-680-7471
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000533653Medicaid
HI0000175543Medicaid