Provider Demographics
NPI:1407144082
Name:VALENCIA, DIEGO ALEXANDER
Entity type:Individual
Prefix:
First Name:DIEGO
Middle Name:ALEXANDER
Last Name:VALENCIA
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 1:801 E KATELLA AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-6614
Mailing Address - Country:US
Mailing Address - Phone:714-633-6373
Mailing Address - Fax:
Practice Address - Street 1:303 W LINCOLN AVE STE 105
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-2928
Practice Address - Country:US
Practice Address - Phone:714-633-6373
Practice Address - Fax:714-633-1443
Is Sole Proprietor?:No
Enumeration Date:2011-07-15
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT132687106H00000X
CAIMF80738106H00000X, 225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist