Healthcare Provider Details

I. General information

NPI: 1356270938
Provider Name (Legal Business Name): JENNIFER VALDIVIEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2089 ROSE VILLA ST
PASADENA CA
91107-5078
US

IV. Provider business mailing address

2151 LOMA VISTA ST
PASADENA CA
91104-4905
US

V. Phone/Fax

Practice location:
  • Phone: 626-396-5800
  • Fax:
Mailing address:
  • Phone: 626-396-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number13250
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: