Healthcare Provider Details

I. General information

NPI: 1285905133
Provider Name (Legal Business Name): TIFFANY D. VALDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2012
Last Update Date: 01/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 W F ST
ONTARIO CA
91762-3205
US

IV. Provider business mailing address

317 W F ST
ONTARIO CA
91762-3205
US

V. Phone/Fax

Practice location:
  • Phone: 909-986-7111
  • Fax: 909-986-0941
Mailing address:
  • Phone: 909-986-7111
  • Fax: 909-986-0941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: