MEDICARE: JENNIFER JOY VALENZUELA

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	101YM0800X	Mental Health Counselor	0000000000	CA

General Provider Information

NPI Number	:	1699367839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER JOY VALENZUELA

Provider Business Mailing Address
First Line	:	2250 W MILL ST SPC 2
Second Line	:
City	:	COLTON
State	:	CA
Zip	:	92324-1049
Country	:	US
Telephone Number	:	909-868-8342
Fax Number	:

Provider Business Practice Location Address
First Line	:	5838 TOSCANA TRCE
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78665-4402
Country	:	US
Telephone Number	:	916-869-2416
Fax Number	:

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

Provider Enumeration Date	:	02/09/2021
Last Update Date	:	02/09/2021

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