Healthcare Provider Details

I. General information

NPI: 1780598326
Provider Name (Legal Business Name): ANTHONY JOSEPH VALENZUELA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 E 12TH ST
OAKLAND CA
94601-3424
US

IV. Provider business mailing address

186 ALDEN RD
CHERRYLAND CA
94541-1702
US

V. Phone/Fax

Practice location:
  • Phone: 510-501-5904
  • Fax: 510-501-5904
Mailing address:
  • Phone: 510-501-5904
  • Fax: 510-501-5904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: