Provider Demographics
NPI:1508563420
Name:VALDOVINOS, JOSE ROBERTO
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ROBERTO
Last Name:VALDOVINOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 FULTON AVE STE 235
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-4299
Mailing Address - Country:US
Mailing Address - Phone:559-827-8334
Mailing Address - Fax:
Practice Address - Street 1:4205 W FIGARDEN DR
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-6051
Practice Address - Country:US
Practice Address - Phone:559-221-1680
Practice Address - Fax:559-221-4336
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician