Provider Demographics
NPI:1376097584
Name:VALDEZ, MIJA (HHA, CMT)
Entity Type:Individual
Prefix:
First Name:MIJA
Middle Name:
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:HHA, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 LINCOLN AVE APT 28
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2629
Mailing Address - Country:US
Mailing Address - Phone:858-522-9277
Mailing Address - Fax:
Practice Address - Street 1:5252 BALBOA AVE STE 701
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6930
Practice Address - Country:US
Practice Address - Phone:858-522-9277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-05
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21510225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist