Healthcare Provider Details

I. General information

NPI: 1811728744
Provider Name (Legal Business Name): CINDY LIZET VALLEJO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1727 MLK JR WAY STE 109
OAKLAND CA
94612-1358
US

IV. Provider business mailing address

498 25TH ST APT 25
OAKLAND CA
94612-2403
US

V. Phone/Fax

Practice location:
  • Phone: 510-380-1709
  • Fax:
Mailing address:
  • Phone: 341-600-4117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: