Provider Demographics
NPI:1679653380
Name:VALENZUELA, GLORIA MARTA (LCSW)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:MARTA
Last Name:VALENZUELA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5855 STREAMVIEW DR.
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105
Mailing Address - Country:US
Mailing Address - Phone:619-287-5460
Mailing Address - Fax:619-287-5040
Practice Address - Street 1:5855 STREAMVIEW DR.
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105
Practice Address - Country:US
Practice Address - Phone:619-287-5460
Practice Address - Fax:619-287-5040
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS229261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC18880FOtherMEDI CAL
CAW5740Medicare ID - Type Unspecified