Healthcare Provider Details

I. General information

NPI: 1992042253
Provider Name (Legal Business Name): OMAR VALADEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2013
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1885 LUNDY AVE SUITE 223
SAN JOSE CA
95131-1887
US

IV. Provider business mailing address

1885 LUNDY AVE STE 223
SAN JOSE CA
95131-1888
US

V. Phone/Fax

Practice location:
  • Phone: 408-284-9010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-23262
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: