Healthcare Provider Details

I. General information

NPI: 1740126861
Provider Name (Legal Business Name): INGRID JOCELYN VALDIVIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1636 CARYWOOD DR
CARY NC
27513-2034
US

IV. Provider business mailing address

1636 CARYWOOD DR
CARY NC
27513-2034
US

V. Phone/Fax

Practice location:
  • Phone: 800-557-6330
  • Fax:
Mailing address:
  • Phone: 919-449-6537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: