Provider Demographics
NPI:1528443942
Name:VALDEZ, JENNIFER (HAD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3830 BROAD ST STE 5
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7187
Mailing Address - Country:US
Mailing Address - Phone:805-547-9500
Mailing Address - Fax:805-547-9502
Practice Address - Street 1:3830 BROAD ST STE 5
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7187
Practice Address - Country:US
Practice Address - Phone:805-547-9500
Practice Address - Fax:805-547-9502
Is Sole Proprietor?:No
Enumeration Date:2015-07-27
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA7899237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist