Provider Demographics
NPI:1558533125
Name:VALDIVIA, WILLIAM ROY I (LICENSED PSYCHIATRIC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ROY
Last Name:VALDIVIA
Suffix:I
Gender:M
Credentials:LICENSED PSYCHIATRIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11410 BROOKSHIRE AVE
Mailing Address - Street 2:#316
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241
Mailing Address - Country:US
Mailing Address - Phone:562-923-4976
Mailing Address - Fax:562-923-4976
Practice Address - Street 1:206 HOSPITAL CIRCLE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683
Practice Address - Country:US
Practice Address - Phone:714-895-1985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL15864167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician