Provider Demographics
NPI:1437284809
Name:VALENCERINA, MADELEINE M (MD)
Entity type:Individual
Prefix:DR
First Name:MADELEINE
Middle Name:M
Last Name:VALENCERINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4500
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-4500
Mailing Address - Country:US
Mailing Address - Phone:714-521-8262
Mailing Address - Fax:714-521-8228
Practice Address - Street 1:14730 BEACH BLVD STE 123
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-4253
Practice Address - Country:US
Practice Address - Phone:714-521-8262
Practice Address - Fax:714-521-8228
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA510432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A510430OtherBLUE CROSS
CA00A510431Medicaid
F51526Medicare UPIN
CA00A510431Medicaid