Healthcare Provider Details

I. General information

NPI: 1255704334
Provider Name (Legal Business Name): JUAN ORLANDO VALLADOLID
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2015
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4333 E VINEYARD AVE
OXNARD CA
93036-1013
US

IV. Provider business mailing address

4333 E VINEYARD AVE
OXNARD CA
93036-1013
US

V. Phone/Fax

Practice location:
  • Phone: 805-981-5500
  • Fax:
Mailing address:
  • Phone: 805-981-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number11481
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: