Healthcare Provider Details

I. General information

NPI: 1104172659
Provider Name (Legal Business Name): IRENE VALENCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2012
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 S C ST STE D
OXNARD CA
93033-4574
US

IV. Provider business mailing address

2500 S C ST STE D
OXNARD CA
93033-4574
US

V. Phone/Fax

Practice location:
  • Phone: 805-248-0544
  • Fax:
Mailing address:
  • Phone: 805-385-9460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW103753
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: