Healthcare Provider Details

I. General information

NPI: 1699340760
Provider Name (Legal Business Name): KENIA VALDOVINOS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 03/01/2025
Certification Date: 03/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 N DATE ST STE 219
ESCONDIDO CA
92025-3413
US

IV. Provider business mailing address

740 CASA REAL CT
VISTA CA
92083-3407
US

V. Phone/Fax

Practice location:
  • Phone: 833-867-4642
  • Fax:
Mailing address:
  • Phone: 760-585-5378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number100986
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: