Organization
CARLOS VALENZUELA
Active
Other names
Sole Proprietor
Organization subpart
No
Provider details
NPI number
Authorized official
CARLOS VALENZUELA (CERTIFIED ORTHOTIST OWNER)
(619) 280-9174
Entity
Organization
Contact information
Practice address
4224 OHIO ST, SAN DIEGO, CA 92104-1320
(619) 280-9174
(619) 280-9286
Mailing address
4224 OHIO ST, SAN DIEGO, CA 92104-1320
(619) 280-9174
(619) 280-9286
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GC000680
—
CA
Enumeration date
08/09/2006
Last updated
09/09/2008
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