Provider Demographics
NPI:1588701106
Name:VALLESCORBO, HERIBERTO (PSYD)
Entity type:Individual
Prefix:DR
First Name:HERIBERTO
Middle Name:
Last Name:VALLESCORBO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N SEMORAN BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-3562
Mailing Address - Country:US
Mailing Address - Phone:415-341-2454
Mailing Address - Fax:
Practice Address - Street 1:50 LAGUNA ST
Practice Address - Street 2:APT. 206
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-6257
Practice Address - Country:US
Practice Address - Phone:415-341-2454
Practice Address - Fax:407-482-2489
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 8946103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical