Provider Demographics
NPI:1659856607
Name:VALDEZ, SUZETTE (MED)
Entity Type:Individual
Prefix:MS
First Name:SUZETTE
Middle Name:
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 CORPORATE CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-6947
Mailing Address - Country:US
Mailing Address - Phone:707-308-2120
Mailing Address - Fax:
Practice Address - Street 1:1670 CORPORATE CIR STE 100
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-6947
Practice Address - Country:US
Practice Address - Phone:707-308-2120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-26
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician