Provider Demographics
NPI:1992116321
Name:VALENCIA MALVEAUX, LLC
Entity type:Organization
Organization Name:VALENCIA MALVEAUX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VALENCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALVEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:504-891-3711
Mailing Address - Street 1:3720 PRYTANIA ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-3733
Mailing Address - Country:US
Mailing Address - Phone:504-891-3711
Mailing Address - Fax:504-891-6353
Practice Address - Street 1:3720 PRYTANIA ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-3733
Practice Address - Country:US
Practice Address - Phone:504-891-3711
Practice Address - Fax:504-891-6353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-20
Last Update Date:2014-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA069856-03363363LA2100X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1439908Medicaid
LA5X718Medicare PIN
LAS73846Medicare UPIN