Healthcare Provider Details

I. General information

NPI: 1518735273
Provider Name (Legal Business Name): ERIC VICTOR VALDIVIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2023
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68257 CALLE AZTECA
DESERT HOT SPRINGS CA
92240-6424
US

IV. Provider business mailing address

66565 DESERT VIEW AVE
DESERT HOT SPRINGS CA
92240-3961
US

V. Phone/Fax

Practice location:
  • Phone: 323-963-1521
  • Fax:
Mailing address:
  • Phone: 323-963-1521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberA053620623
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: