Provider Demographics
NPI:1699583294
Name:VALADEZ, MARIANA
Entity type:Individual
Prefix:
First Name:MARIANA
Middle Name:
Last Name:VALADEZ
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 1:225 ALTAIR AVE
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-1423
Mailing Address - Country:US
Mailing Address - Phone:805-743-7264
Mailing Address - Fax:
Practice Address - Street 1:225 ALTAIR AVE
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-1423
Practice Address - Country:US
Practice Address - Phone:805-743-7264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-28
Last Update Date:2024-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator