Provider Demographics
NPI:1649394586
Name:VALLE, KARINA RODRIGUEZ (MSW)
Entity Type:Individual
Prefix:MS
First Name:KARINA
Middle Name:RODRIGUEZ
Last Name:VALLE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:218 CARMEN LN
Mailing Address - Street 2:STE 108
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-7773
Mailing Address - Country:US
Mailing Address - Phone:805-929-3211
Mailing Address - Fax:805-929-6359
Practice Address - Street 1:218 CARMEN LN
Practice Address - Street 2:STE 108
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-7773
Practice Address - Country:US
Practice Address - Phone:805-614-7272
Practice Address - Fax:805-614-7273
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW190201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70477FMedicaid
CA051872Medicare Oscar/Certification
CAW1508GMedicare PIN