Provider Demographics
NPI:1629853007
Name:VALDEZ, JENAY ASHLEY
Entity Type:Individual
Prefix:
First Name:JENAY
Middle Name:ASHLEY
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 1:10526 DUBNOFF WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-3921
Mailing Address - Country:US
Mailing Address - Phone:818-755-4950
Mailing Address - Fax:818-752-0783
Practice Address - Street 1:10526 DUBNOFF WAY
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3921
Practice Address - Country:US
Practice Address - Phone:818-755-4950
Practice Address - Fax:818-752-0783
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-2633765OtherMEDICAL