Healthcare Provider Details

I. General information

NPI: 1134040496
Provider Name (Legal Business Name): JAIR VALDIVIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4749 E WESLEY DR
ANAHEIM CA
92807-1941
US

IV. Provider business mailing address

902 S SYLVAN ST
ANAHEIM CA
92804-4033
US

V. Phone/Fax

Practice location:
  • Phone: 714-208-5112
  • Fax: 866-304-7530
Mailing address:
  • Phone: 714-353-7737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: