Provider Demographics
NPI:1962950162
Name:ALDAMA, CRISTINA VALENTINE
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:VALENTINE
Last Name:ALDAMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CRISTINA
Other - Middle Name:VALENTINE
Other - Last Name:INTHAVONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1260 MARILLE LN
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-3386
Mailing Address - Country:US
Mailing Address - Phone:408-835-2821
Mailing Address - Fax:
Practice Address - Street 1:1760 LOYOLA DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-2047
Practice Address - Country:US
Practice Address - Phone:408-835-2821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor