Provider Demographics
NPI:1699432799
Name:VALDEZ, MARTIN O
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:O
Last Name:VALDEZ
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 1:18361 STRATHERN ST UNIT 4
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-1375
Mailing Address - Country:US
Mailing Address - Phone:310-405-1806
Mailing Address - Fax:
Practice Address - Street 1:18361 STRATHERN ST UNIT 4
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-1375
Practice Address - Country:US
Practice Address - Phone:310-405-1806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst