Healthcare Provider Details

I. General information

NPI: 1245980135
Provider Name (Legal Business Name): RAFAEL VALDOVINOS ACSW126737
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E CYPRESS AVE
LOMPOC CA
93436-6806
US

IV. Provider business mailing address

401 E CYPRESS AVE
LOMPOC CA
93436-6806
US

V. Phone/Fax

Practice location:
  • Phone: 805-737-6690
  • Fax:
Mailing address:
  • Phone: 805-737-6690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberACSW126737
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: