MEDICARE: MARIA A. VALDOVINOS CASE MANAGER

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	ASW71859	CA
2	171M00000X	Case Manager/Care Coordinator
3	1041C0700X	Clinical Social Worker	LCSW93185	CA

General Provider Information

NPI Number	:	1720355407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA A. VALDOVINOS CASE MANAGER

Provider Business Mailing Address
First Line	:	2677 ZOE AVE STE 114
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-6995
Country	:	US
Telephone Number	:	323-923-9559
Fax Number	:	323-923-9566

Provider Business Practice Location Address
First Line	:	2677 ZOE AVE STE 114
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-6995
Country	:	US
Telephone Number	:	323-923-9559
Fax Number	:	323-923-9566

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

Provider Enumeration Date	:	11/22/2011
Last Update Date	:	12/17/2019

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