Healthcare Provider Details

I. General information

NPI: 1811728744
Provider Name (Legal Business Name): CINDY LIZET VALLEJO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 CENTER ST STE 200
BERKELEY CA
94704-1386
US

IV. Provider business mailing address

334 STAPLES AVE
SAN FRANCISCO CA
94112-1839
US

V. Phone/Fax

Practice location:
  • Phone: 510-548-8283
  • Fax: 510-548-2938
Mailing address:
  • Phone: 310-259-9092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: