Healthcare Provider Details

I. General information

NPI: 1639877368
Provider Name (Legal Business Name): IZABELLA ROSE VALDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2023
Last Update Date: 02/22/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31896 CLINTON AVE
HOMELAND CA
92548-9009
US

IV. Provider business mailing address

31896 CLINTON AVE
HOMELAND CA
92548-9009
US

V. Phone/Fax

Practice location:
  • Phone: 626-272-0464
  • Fax:
Mailing address:
  • Phone: 626-272-0464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberY9504311
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: