Healthcare Provider Details

I. General information

NPI: 1154858967
Provider Name (Legal Business Name): JENNIFER VALENCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER MEDINA

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 11/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1231 E DYER RD
SANTA ANA CA
92705-5606
US

IV. Provider business mailing address

1231 E DYER RD STE 135
SANTA ANA CA
92705-5643
US

V. Phone/Fax

Practice location:
  • Phone: 949-250-0488
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW75976
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: