Provider Demographics
NPI:1194126763
Name:VALDEZ, OSCAR IVAN (LMFT)
Entity type:Individual
Prefix:
First Name:OSCAR
Middle Name:IVAN
Last Name:VALDEZ
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20809
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92516-0809
Mailing Address - Country:US
Mailing Address - Phone:909-258-7685
Mailing Address - Fax:
Practice Address - Street 1:3400 CENTRAL AVE STE 215
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2175
Practice Address - Country:US
Practice Address - Phone:951-934-8944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-14
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108587106H00000X
CA131261106H00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health