Healthcare Provider Details

I. General information

NPI: 1659829745
Provider Name (Legal Business Name): KASEY ALEXIS VALENCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2016
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N CRESCENT WAY
ANAHEIM CA
92801-5401
US

IV. Provider business mailing address

501 N CRESCENT WAY
ANAHEIM CA
92801-5401
US

V. Phone/Fax

Practice location:
  • Phone: 714-999-3511
  • Fax:
Mailing address:
  • Phone: 714-999-3511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number220146655
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: