Provider Demographics
NPI:1720890239
Name:BEZAMA JIMENEZ, VALERIA IGNACIA
Entity type:Individual
Prefix:
First Name:VALERIA
Middle Name:IGNACIA
Last Name:BEZAMA JIMENEZ
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 1:800 W MAIN
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272
Mailing Address - Country:US
Mailing Address - Phone:360-805-3122
Mailing Address - Fax:360-805-9180
Practice Address - Street 1:800 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272
Practice Address - Country:US
Practice Address - Phone:360-805-3122
Practice Address - Fax:360-805-9180
Is Sole Proprietor?:No
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61617853101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health