Provider Demographics
NPI:1053978072
Name:VALENZUELA, ESTHER M JR
Entity type:Individual
Prefix:
First Name:ESTHER
Middle Name:M
Last Name:VALENZUELA
Suffix:JR
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 1:1015 CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-2909
Mailing Address - Country:US
Mailing Address - Phone:925-634-1751
Mailing Address - Fax:
Practice Address - Street 1:1015 CRESCENT DR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-2909
Practice Address - Country:US
Practice Address - Phone:925-634-1751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA333208163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
L-34730OtherIBCLC