Percival Valenzuela, IDC

Primary specialty

Independent Duty CorpsmanTaxonomy code 1710I1002X

Practice address

1865 Cove Rd
BLDG 3806
Norfolk, VA 23521-2911

Phone

(757) 462-3780

Fax

(757) 462-4825

NPI assigned

Jun 11, 2008

Last updated

Jun 11, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1213142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213142400000",
    "number": "1427218726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1865 COVE RD",
            "address_2": "BLDG 3806",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235212911",
            "telephone_number": "757-462-3780",
            "fax_number": "757-462-4825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1865 COVE RD",
            "address_2": "BLDG 3806",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235212911",
            "telephone_number": "757-462-3780",
            "fax_number": "757-462-4825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VALENZUELA",
        "first_name": "PERCIVAL",
        "credential": "IDC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-11",
        "last_updated": "2008-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "146N00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medical Technician, Basic",
            "state": "ZZ",
            "license": "B1505257",
            "primary": false
        },
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Validation Counseling Services
• Nicholas Joseph Valle, DO
• Jaxon Vallely
• Mitchell Vallone, DO

• Independent Duty Corpsman in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Independent Duty Corpsman in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.