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General NPI Number Information
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NPI Number | 1124896303
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Entity Type | Individual
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Provider Name | JOSE DE JESUS VALDIVIA JR.
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Gender | Male
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Dates
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Enumeration Date | 12/18/2023
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 4190 SEQUOIA ST
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City | RIVERSIDE
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State | CA
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Zip | 92503-3639
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Country | US
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Telephone | 951-824-0948
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Fax |
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Provider Business Mailing Address
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Address Line | 1274 CENTER COURT DR STE 211
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City | COVINA
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State | CA
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Zip | 91724-3668
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Country | US
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Telephone | 626-339-4999
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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