MEDICARE: JESSICA VALENZUELA PH.D.

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	103TC2200X	Clinical Child & Adolescent Psychologist	8279	FL

General Provider Information

NPI Number	:	1649507997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA VALENZUELA PH.D.

Provider Business Mailing Address
First Line	:	3301 COLLEGE AVE
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33314-7721
Country	:	US
Telephone Number	:	954-262-5737
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 S ANDREWS AVE
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33316-2510
Country	:	US
Telephone Number	:	954-262-5737
Fax Number	:

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

Provider Enumeration Date	:	11/06/2009
Last Update Date	:	01/20/2026

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