Healthcare Provider Details

I. General information

NPI: 1194126763
Provider Name (Legal Business Name): OSCAR IVAN VALDEZ LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2014
Last Update Date: 05/20/2022
Certification Date: 05/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CENTRAL AVE STE 215
RIVERSIDE CA
92506-2175
US

IV. Provider business mailing address

PO BOX 20809
RIVERSIDE CA
92516-0809
US

V. Phone/Fax

Practice location:
  • Phone: 951-934-8944
  • Fax:
Mailing address:
  • Phone: 909-258-7685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number108587
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number131261
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: