Healthcare Provider Details

I. General information

NPI: 1710489877
Provider Name (Legal Business Name): OLIVIA LEON VALLE RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2018
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3186 AIRWAY AVE STE A
COSTA MESA CA
92626-4650
US

IV. Provider business mailing address

23821 BARRETT DR
LAKE FOREST CA
92630-2802
US

V. Phone/Fax

Practice location:
  • Phone: 714-881-0427
  • Fax:
Mailing address:
  • Phone: 949-813-6334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number12148087
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: