Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | ||
N | 103T00000X | Psychologist | ||
N | 103TA0700X | Adult Development & Aging Psychologist | ||
N | 103TB0200X | Cognitive & Behavioral Psychologist | ||
N | 103TC2200X | Clinical Child & Adolescent Psychologist |
NPI | 1245744622 |
---|---|
Provider Name | Michelle Valenzuela |
First Address | Long Beach, CA 90805-6510 |
Second Address | Long Beach, CA 90805-6510 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2017 |
Last Update Date | 14/09/2018 |