Valencia, Mauricio
Valencia, Mauricio is an individual health care provider with primary practice located at 850 Busse Hwy , Park Ridge IL 60068-2302. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is his primary health care specialty. Valencia, Mauricio can be contacted via phone (847) 759-4770.Contact Information
Primary practice address
850 Busse Hwy
Park Ridge IL 60068-2302
Phone: (847) 759-4770
Fax: (847) 759-8824
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner | 363L00000X | 10933 | Wisconsin |
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | 209.017085 | Illinois |
Profile Details
| NPI number | 1134636228 |
|---|---|
| LBN Legal business name | Valencia, Mauricio |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 10th, 2018 |
| Last updated | Dec 16th, 2022 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1134636228 | NPPES |
| Wisconsin | MEDICAID | 100170179 |
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