Provider Demographics
NPI:1063108967
Name:VAN VALEN, ALEXANDER MICAH
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:MICAH
Last Name:VAN VALEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 E MICHELTORENA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-1905
Mailing Address - Country:US
Mailing Address - Phone:805-602-1195
Mailing Address - Fax:
Practice Address - Street 1:107 E MICHELTORENA ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-1905
Practice Address - Country:US
Practice Address - Phone:805-602-1195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-13
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker