Healthcare Provider Details

I. General information

NPI: 1124397617
Provider Name (Legal Business Name): GILBERTO VALENCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2011
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 POLLASKY AVE STE D
CLOVIS CA
93612-1159
US

IV. Provider business mailing address

PO BOX 1666
CLOVIS CA
93613-1666
US

V. Phone/Fax

Practice location:
  • Phone: 559-203-3775
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number131373
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: