Provider Demographics
NPI:1518069699
Name:VALTIERRA, BEVERLY JANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:JANE
Last Name:VALTIERRA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7410 BLANCO RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-4364
Mailing Address - Country:US
Mailing Address - Phone:210-366-1662
Mailing Address - Fax:210-344-9255
Practice Address - Street 1:7410 BLANCO RD STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-4364
Practice Address - Country:US
Practice Address - Phone:210-366-1662
Practice Address - Fax:210-344-9255
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00S07KMedicare ID - Type Unspecified