Provider Demographics
NPI:1144671132
Name:BELLA-VALENZUELA, JAYDA
Entity type:Individual
Prefix:
First Name:JAYDA
Middle Name:
Last Name:BELLA-VALENZUELA
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 1:11351 JAMES WATT DR
Mailing Address - Street 2:STE A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-6605
Mailing Address - Country:US
Mailing Address - Phone:915-849-6602
Mailing Address - Fax:915-849-6603
Practice Address - Street 1:11351 JAMES WATT DR STE A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-6605
Practice Address - Country:US
Practice Address - Phone:915-849-6602
Practice Address - Fax:915-849-6603
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation