=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962208363
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SABRINA VALDEZ LICSW
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2025
-----------------------------------------------------
Last Update Date | 02/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4275 EXECUTIVE SQ STE 200
-----------------------------------------------------
City | LA JOLLA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92037-1476
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-318-7294
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2127 OLYMPIC PKWY STE 1006
-----------------------------------------------------
City | CHULA VISTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91915-1361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MENTAL HEALTH PROVIDER
-----------------------------------------------------
Name | SABRINA VALDEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 858-318-7294
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------