Provider Demographics
NPI:1114243029
Name:VALDES, JAN ALFRED BALINO (MA, MFT)
Entity Type:Individual
Prefix:MR
First Name:JAN ALFRED
Middle Name:BALINO
Last Name:VALDES
Suffix:
Gender:M
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 262561
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92196-2561
Mailing Address - Country:US
Mailing Address - Phone:619-535-0085
Mailing Address - Fax:
Practice Address - Street 1:9051 MIRA MESA BLVD
Practice Address - Street 2:262561
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126
Practice Address - Country:US
Practice Address - Phone:619-535-0085
Practice Address - Fax:844-273-4070
Is Sole Proprietor?:No
Enumeration Date:2010-04-16
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101103106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist