Provider Demographics
NPI:1033707823
Name:VALENZUELA, JORDAN L (CMT)
Entity type:Individual
Prefix:MS
First Name:JORDAN
Middle Name:L
Last Name:VALENZUELA
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:LEIGH
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CMT
Mailing Address - Street 1:1083 HARTNELL AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-2115
Mailing Address - Country:US
Mailing Address - Phone:530-605-0071
Mailing Address - Fax:
Practice Address - Street 1:1083 HARTNELL AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-2115
Practice Address - Country:US
Practice Address - Phone:530-605-0071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66704225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist