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General NPI Number Information
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NPI Number | 1831469568
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Entity Type | Organization
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Legal Business Name | VALDIVIA INC
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Dates
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Enumeration Date | 01/11/2012
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Last Update Date | 01/11/2012
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Provider Practice Location Address
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Address Line | 540 N GOLDEN CIRCLE DR SUITE 203
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City | SANTA ANA
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State | CA
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Zip | 92705-3914
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Country | US
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Telephone | 714-480-1111
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Fax | 714-480-1112
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Provider Business Mailing Address
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Address Line | 540 N GOLDEN CIRCLE DR SUITE 203
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City | SANTA ANA
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State | CA
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Zip | 92705-3914
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Country | US
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Telephone | 714-480-1111
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Fax | 714-480-1112
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LINO VALDIVIA
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Credential | PSY.D
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Telephone | 714-480-1111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | PSY10220
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License Number State | CA
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