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General NPI Number Information
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NPI Number | 1518242387
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Entity Type | Individual
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Provider Name | DOMINIC PATRICK VALDES LCSW
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Gender | Male
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Dates
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Enumeration Date | 10/12/2011
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 1480 VINE ST APT 701
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City | LOS ANGELES
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State | CA
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Zip | 90028-8161
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Country | US
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Telephone | 213-549-3222
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Fax |
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Provider Business Mailing Address
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Address Line | 1480 VINE ST APT 701
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City | LOS ANGELES
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State | CA
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Zip | 90028-8161
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Country | US
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Telephone | 213-549-3222
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 71010
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | ASW30539
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License Number State | CA
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