Healthcare Provider Details

I. General information

NPI: 1861645889
Provider Name (Legal Business Name): RAUL VALDEZ LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2008
Last Update Date: 11/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR NMCSD
SAN DIEGO CA
92134-1098
US

IV. Provider business mailing address

1470 HIDDEN MESA TRL
EL CAJON CA
92019-3801
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-8038
  • Fax:
Mailing address:
  • Phone: 619-368-6426
  • Fax: 619-334-0448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberRA819095
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberRPS2008066
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801074762
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: