MEDICARE: ELIZABETH CHANTEL VALDIVIA AMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	157450	CA

General Provider Information

NPI Number	:	1013868439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH CHANTEL VALDIVIA AMFT

Provider Business Mailing Address
First Line	:	PO BOX 8625
Second Line	:
City	:	MORENO VALLEY
State	:	CA
Zip	:	92552-8625
Country	:	US
Telephone Number	:	951-459-5436
Fax Number	:

Provider Business Practice Location Address
First Line	:	2350 BUHNE ST
Second Line	:
City	:	EUREKA
State	:	CA
Zip	:	95501-3238
Country	:	US
Telephone Number	:	707-443-4593
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2026
Last Update Date	:	02/09/2026

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