Healthcare Provider Details

I. General information

NPI: 1316460611
Provider Name (Legal Business Name): CHRISTIAN EFRAIN VALDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8755 AERO DRIVE SUITE 230
SAN DIEGO CA
92123
US

IV. Provider business mailing address

8755 AERO DRIVE SUITE 230
SAN DIEGO CA
92123
US

V. Phone/Fax

Practice location:
  • Phone: 858-256-2180
  • Fax:
Mailing address:
  • Phone: 858-256-2180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: