Provider Demographics
NPI:1740141613
Name:VALLEJO DEANDA, ALICIA (CHW)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:VALLEJO DEANDA
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4990 ARLINGTON AVE STE D
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-2757
Mailing Address - Country:US
Mailing Address - Phone:951-785-9011
Mailing Address - Fax:951-785-1436
Practice Address - Street 1:4990 ARLINGTON AVE STE D
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-2757
Practice Address - Country:US
Practice Address - Phone:951-785-9011
Practice Address - Fax:951-785-1436
Is Sole Proprietor?:No
Enumeration Date:2025-11-20
Last Update Date:2025-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39805172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker