Provider Demographics
NPI:1497400071
Name:VALDEZ, CHALYN FAYE QUINONES
Entity Type:Individual
Prefix:
First Name:CHALYN FAYE
Middle Name:QUINONES
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 W KETTLEMAN LN
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-6006
Mailing Address - Country:US
Mailing Address - Phone:209-362-8871
Mailing Address - Fax:
Practice Address - Street 1:1411 W 190TH ST
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-4324
Practice Address - Country:US
Practice Address - Phone:310-719-3908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-13
Last Update Date:2022-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician