MEDICARE: MRS. GRISELDA VALLES-DE LA CRUZ B.S.

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	175T00000X	Peer Specialist	MPSS-XUPIDN	CA
2	373H00000X	Day Training/Habilitation Specialist
3	172V00000X	Community Health Worker		CA
4	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1053620252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GRISELDA VALLES-DE LA CRUZ B.S.

Provider Business Mailing Address
First Line	:	679 S NEW HAMPSHIRE AVE STE 400
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-1355
Country	:	US
Telephone Number	:	213-639-2500
Fax Number	:

Provider Business Practice Location Address
First Line	:	679 S NEW HAMPSHIRE AVE STE 400
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-1355
Country	:	US
Telephone Number	:	213-639-2500
Fax Number	:

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

Provider Enumeration Date	:	10/05/2010
Last Update Date	:	02/23/2026

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