Provider Demographics
NPI:1194261289
Name:VALLEJOS, NATALIA (PSYD)
Entity type:Individual
Prefix:DR
First Name:NATALIA
Middle Name:
Last Name:VALLEJOS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12499 BRANTLEY COMMONS CT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-5676
Mailing Address - Country:US
Mailing Address - Phone:239-278-3443
Mailing Address - Fax:
Practice Address - Street 1:12499 BRANTLEY COMMONS CT
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-5676
Practice Address - Country:US
Practice Address - Phone:239-278-3443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9782103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical