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NPI Code Detail

MEDICARE: VIVIAN VALDEZ PSYD

MEDICARE:   VIVIAN  VALDEZ  PSYD
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
1103T00000XPsychologist

General Provider Information

NPI Number : 1336628205
Entity Type Code : Individual
Provider Name (Legal Business Name) : VIVIAN VALDEZ PSYD
Provider Business Mailing Address
First Line : 10323 SANTA MONICA BLVD STE 111
Second Line :
City : LOS ANGELES
State : CA
Zip : 90025-5056
Country : US
Telephone Number : 510-333-4595
Fax Number :
Provider Business Practice Location Address
First Line : 10323 SANTA MONICA BLVD STE 111
Second Line :
City : LOS ANGELES
State : CA
Zip : 90025-5056
Country : US
Telephone Number : 510-333-4595
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2018
Last Update Date : 12/10/2018

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Directions to “ VIVIAN VALDEZ PSYD” Practice Location

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