Healthcare Provider Details

I. General information

NPI: 1508666744
Provider Name (Legal Business Name): SUSAN VALDEZ COUCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4721 VISTA GRANDE DR
ANTIOCH CA
94531-8619
US

IV. Provider business mailing address

556 CAPITOL DR
BENICIA CA
94510-1308
US

V. Phone/Fax

Practice location:
  • Phone: 925-779-7475
  • Fax:
Mailing address:
  • Phone: 707-580-3718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: