Provider Demographics
NPI:1336461334
Name:VALDEZ, MARIO MICHAEL (AA)
Entity Type:Individual
Prefix:MR
First Name:MARIO
Middle Name:MICHAEL
Last Name:VALDEZ
Suffix:
Gender:M
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5723 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-4222
Mailing Address - Country:US
Mailing Address - Phone:323-728-0100
Mailing Address - Fax:323-728-9218
Practice Address - Street 1:5723 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-4222
Practice Address - Country:US
Practice Address - Phone:323-728-0100
Practice Address - Fax:323-728-9218
Is Sole Proprietor?:No
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)