Provider Demographics
NPI:1639719933
Name:VALDOVINOS, SARAI
Entity Type:Individual
Prefix:
First Name:SARAI
Middle Name:
Last Name:VALDOVINOS
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 1:1039 N BRIERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-3992
Mailing Address - Country:US
Mailing Address - Phone:626-634-9191
Mailing Address - Fax:
Practice Address - Street 1:19195 US HIGHWAY 18 STE 104
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2562
Practice Address - Country:US
Practice Address - Phone:888-557-1305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA16S00000XOtherBEHAVIOR TECHNICIAN