Healthcare Provider Details

I. General information

NPI: 1932869518
Provider Name (Legal Business Name): VERONICA JUNE VALENTINCIC PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2021
Last Update Date: 12/23/2021
Certification Date: 12/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16541 GOTHARD ST
HUNTINGTON BEACH CA
92647-4471
US

IV. Provider business mailing address

14111 SAWSTON CIR
WESTMINSTER CA
92683-4133
US

V. Phone/Fax

Practice location:
  • Phone: 714-375-1110
  • Fax:
Mailing address:
  • Phone: 714-504-1783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95019531
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: