Healthcare Provider Details

I. General information

NPI: 1851639363
Provider Name (Legal Business Name): ALBERT VALENZUELA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2013
Last Update Date: 01/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 N CEDAR AVE STE 108
FRESNO CA
93726-2538
US

IV. Provider business mailing address

4147 E CORNELL AVE
FRESNO CA
93703-1408
US

V. Phone/Fax

Practice location:
  • Phone: 559-248-1548
  • Fax: 559-248-1530
Mailing address:
  • Phone: 559-579-2170
  • Fax: 559-248-1548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: