Healthcare Provider Details

I. General information

NPI: 1134320211
Provider Name (Legal Business Name): VALERIA SUA CADC-II
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6154 MISSION GORGE RD SUITE 120
SAN DIEGO CA
92120-3493
US

IV. Provider business mailing address

4772 WIGHTMAN ST
SAN DIEGO CA
92105-2854
US

V. Phone/Fax

Practice location:
  • Phone: 619-285-1718
  • Fax: 619-285-3803
Mailing address:
  • Phone: 619-509-3426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAADE
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: