Healthcare Provider Details

I. General information

NPI: 1427717610
Provider Name (Legal Business Name): MS. SANDRA ELISA VALENCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2021
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 E ST
FRESNO CA
93706-2024
US

IV. Provider business mailing address

1235 E ST
FRESNO CA
93706-2024
US

V. Phone/Fax

Practice location:
  • Phone: 559-268-6261
  • Fax:
Mailing address:
  • Phone: 559-268-6261
  • Fax: 559-268-7518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number9562
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: