Healthcare Provider Details

I. General information

NPI: 1083266365
Provider Name (Legal Business Name): ANGELICA VALENCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 W THOUSAND OAKS BLVD STE 600
THOUSAND OAKS CA
91360-4463
US

IV. Provider business mailing address

125 W THOUSAND OAKS BLVD
THOUSAND OAKS CA
91360-4402
US

V. Phone/Fax

Practice location:
  • Phone: 805-418-9100
  • Fax:
Mailing address:
  • Phone: 805-777-3505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number126086
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: