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General NPI Number Information
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NPI Number | 1649607458
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Entity Type | Individual
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Provider Name | JARED VALENTINE
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Gender | Male
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Dates
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Enumeration Date | 10/11/2013
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Last Update Date | 10/11/2013
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Provider Practice Location Address
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Address Line | 6500 ZUMA VIEW PL
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City | MALIBU
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State | CA
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Zip | 90265-4327
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Country | US
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Telephone | 310-579-5192
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Fax |
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Provider Business Mailing Address
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Address Line | 6500 ZUMA VIEW PL
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City | MALIBU
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State | CA
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Zip | 90265-4327
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Country | US
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Telephone | 310-579-5192
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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 | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State | CA
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