Provider Demographics
NPI:1508456062
Name:VALDEZ VALDEZ, XIOMARA JANETH (RBT)
Entity Type:Individual
Prefix:MRS
First Name:XIOMARA
Middle Name:JANETH
Last Name:VALDEZ VALDEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21520 INMAN PARK PL
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-4593
Mailing Address - Country:US
Mailing Address - Phone:571-296-7282
Mailing Address - Fax:
Practice Address - Street 1:22375 BRODERICK DR STE 125
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-9345
Practice Address - Country:US
Practice Address - Phone:571-375-0214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-20-148586106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician