Healthcare Provider Details

I. General information

NPI: 1558277210
Provider Name (Legal Business Name): PRISCILA VALDIVIA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11848 BERNARDO PLAZA CT STE 100
SAN DIEGO CA
92128-2417
US

IV. Provider business mailing address

11848 BERNARDO PLAZA CT STE 100
SAN DIEGO CA
92128-2417
US

V. Phone/Fax

Practice location:
  • Phone: 858-217-2496
  • Fax: 888-493-4898
Mailing address:
  • Phone: 858-217-2496
  • Fax: 888-493-4898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPT310376
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: