MEDICARE: DR. DEBORAH LEE VALENZUELA 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
1	103TC0700X	Clinical Psychologist	20574	CA

General Provider Information

NPI Number	:	1841473147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEBORAH LEE VALENZUELA PSYD

Provider Business Mailing Address
First Line	:	3628 MADISON AVE STE 6
Second Line	:
City	:	N HIGHLANDS
State	:	CA
Zip	:	95660-5070
Country	:	US
Telephone Number	:	916-947-7300
Fax Number	:

Provider Business Practice Location Address
First Line	:	3628 MADISON AVE STE 6
Second Line	:
City	:	N HIGHLANDS
State	:	CA
Zip	:	95660-5070
Country	:	US
Telephone Number	:	916-947-7300
Fax Number	:

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

Provider Enumeration Date	:	12/10/2007
Last Update Date	:	12/07/2018

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