Provider Demographics
NPI:1114166402
Name:VALENZUELA, JOHN A (PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:VALENZUELA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 W OJAI AVE STE 101
Mailing Address - Street 2:PMB #352
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-3278
Mailing Address - Country:US
Mailing Address - Phone:323-364-4035
Mailing Address - Fax:
Practice Address - Street 1:108 E MATILIJA ST
Practice Address - Street 2:
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-2639
Practice Address - Country:US
Practice Address - Phone:323-364-4035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32439103TC2200X, 103TC1900X
251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No251B00000XAgenciesCase Management