Provider Demographics
NPI:1851133144
Name:VALENZUELA, LILIAN
Entity type:Individual
Prefix:
First Name:LILIAN
Middle Name:
Last Name:VALENZUELA
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 1:121 E ORANGEBURG AVE STE 16
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-5340
Mailing Address - Country:US
Mailing Address - Phone:209-585-3321
Mailing Address - Fax:
Practice Address - Street 1:121 E ORANGEBURG AVE STE 16
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-5340
Practice Address - Country:US
Practice Address - Phone:209-585-3321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician