MEDICARE: ROSA ANGELICA VALDOVINOS SUDCC III-CS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	5823	CA

General Provider Information

NPI Number	:	1598184558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSA ANGELICA VALDOVINOS SUDCC III-CS

Provider Business Mailing Address
First Line	:	14515 HAMLIN ST STE 100
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91411-1694
Country	:	US
Telephone Number	:	818-212-6710
Fax Number	:

Provider Business Practice Location Address
First Line	:	14515 HAMLIN ST STE 100
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91411-1694
Country	:	US
Telephone Number	:	818-212-6710
Fax Number	:

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

Provider Enumeration Date	:	04/07/2014
Last Update Date	:	04/02/2025

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