Provider Demographics
NPI:1154445260
Name:VALDIVIA, AIDA HORTENCIA
Entity type:Individual
Prefix:MS
First Name:AIDA
Middle Name:HORTENCIA
Last Name:VALDIVIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8550 BALBOA BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-3562
Mailing Address - Country:US
Mailing Address - Phone:818-830-0200
Mailing Address - Fax:
Practice Address - Street 1:8550 BALBOA BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-3562
Practice Address - Country:US
Practice Address - Phone:818-830-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist