Provider Demographics
NPI:1225707706
Name:VALVERDE, JUSTINE ILENE (BA)
Entity Type:Individual
Prefix:MRS
First Name:JUSTINE
Middle Name:ILENE
Last Name:VALVERDE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:JUSTINE
Other - Middle Name:I
Other - Last Name:VALVERDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:148 E HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-4314
Mailing Address - Country:US
Mailing Address - Phone:909-684-4613
Mailing Address - Fax:
Practice Address - Street 1:148 E HOLLY ST
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-4314
Practice Address - Country:US
Practice Address - Phone:909-684-4613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician