Healthcare Provider Details

I. General information

NPI: 1649507997
Provider Name (Legal Business Name): JESSICA VALENZUELA PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2009
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S ANDREWS AVE
FT LAUDERDALE FL
33316-2510
US

IV. Provider business mailing address

3301 COLLEGE AVE
DAVIE FL
33314-7721
US

V. Phone/Fax

Practice location:
  • Phone: 954-262-5737
  • Fax:
Mailing address:
  • Phone: 954-262-5737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number8279
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: