Basic Information
| Provider Information | |||||||||
| NPI: | 1306002712 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VALDEZ | ||||||||
| FirstName: | VICTOR | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LADAAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4660 EL CAJON BLVD STE 210 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921154466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195977335 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4660 EL CAJON BLVD STE 210 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195977335 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2008 | ||||||||
| LastUpdateDate: | 06/06/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 081765 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.