Basic Information
| Provider Information | |||||||||
| NPI: | 1609225523 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VALDEZ | ||||||||
| FirstName: | JESSE | ||||||||
| MiddleName: | NAJERA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 915 N MILPAS ST | ||||||||
| Address2: | FL 2 | ||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931032331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056177850 | ||||||||
| FaxNumber: | 8059638880 | ||||||||
| Practice Location | |||||||||
| Address1: | 915 N MILPAS ST | ||||||||
| Address2: | FL 2 | ||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931032331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056177850 | ||||||||
| FaxNumber: | 8059638880 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2016 | ||||||||
| LastUpdateDate: | 06/10/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PSY13824 | CA | N | Behavioral Health & Social Service Providers | Psychologist | 103T00000X | PSY 0001224 | CO | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.