Healthcare Provider Details

I. General information

NPI: 1821647405
Provider Name (Legal Business Name): JOHNNY VALERA JR. LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2019
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11015 BLOOMFIELD AVE
SANTA FE SPRINGS CA
90670-4601
US

IV. Provider business mailing address

13963 DUNTON DR
WHITTIER CA
90605-2612
US

V. Phone/Fax

Practice location:
  • Phone: 562-906-2676
  • Fax:
Mailing address:
  • Phone: 562-298-6309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number121625
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: