Basic Information
| Provider Information | |||||||||
| NPI: | 1700947074 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VALDEZ | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | TERESA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.H.R.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 482 W SAN YSIDRO BLVD | ||||||||
| Address2: | 1535 | ||||||||
| City: | SAN YSIDRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921732444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194274661 | ||||||||
| FaxNumber: | 6194267849 | ||||||||
| Practice Location | |||||||||
| Address1: | 835 3RD AVE | ||||||||
| Address2: | C | ||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919111352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194274661 | ||||||||
| FaxNumber: | 6194267849 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 03/17/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.