Provider Demographics
NPI:1194206797
Name:VALDEZ, CRYSTAL RUBY (ACSW)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:RUBY
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 S. GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-5000
Mailing Address - Country:US
Mailing Address - Phone:626-335-5980
Mailing Address - Fax:626-335-5989
Practice Address - Street 1:1160 S. GRAND AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-5000
Practice Address - Country:US
Practice Address - Phone:626-335-5980
Practice Address - Fax:626-335-5989
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2019-11-27
Deactivation Date:2019-11-04
Deactivation Code:
Reactivation Date:2019-11-27
Provider Licenses
StateLicense IDTaxonomies
CA92448101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health