Healthcare Provider Details

I. General information

NPI: 1740308477
Provider Name (Legal Business Name): PATRICIA DEL VALLE PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 S GRAND AVE
GLENDORA CA
91740-5000
US

IV. Provider business mailing address

1160 S GRAND AVE
GLENDORA CA
91740-5000
US

V. Phone/Fax

Practice location:
  • Phone: 626-807-1783
  • Fax:
Mailing address:
  • Phone: 626-335-5980
  • Fax: 626-335-5989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY23550
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: