Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003107251 |
---|---|
Provider Name | Alejandro Valencia |
First Address | San Diego, CA 92111-5702 |
Second Address | El Cajon, CA 92020-7315 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2011 |
Last Update Date | 22/04/2011 |