Provider Demographics
NPI:1902249436
Name:VALENCIA, ALEX JOSEPH (IDC)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:JOSEPH
Last Name:VALENCIA
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 GLEN COVE
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-3004
Mailing Address - Country:US
Mailing Address - Phone:520-256-3319
Mailing Address - Fax:
Practice Address - Street 1:3005 GLEN COVE
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-3004
Practice Address - Country:US
Practice Address - Phone:520-256-3319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman