Provider Demographics
NPI:1396551404
Name:VALENCIA, ALICIA
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:VALENCIA
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 1:1583 N MOUNTAIN VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92405-4606
Mailing Address - Country:US
Mailing Address - Phone:909-402-8268
Mailing Address - Fax:
Practice Address - Street 1:4055 OCEANSIDE BLVD STE T
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-5821
Practice Address - Country:US
Practice Address - Phone:909-402-8268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-04
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician