Provider Demographics
NPI:1679812523
Name:MOENNICH, ANA VALENZUELA
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:VALENZUELA
Last Name:MOENNICH
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 1:42220 LAKE HUGHES RD
Mailing Address - Street 2:
Mailing Address - City:LAKE HUGHES
Mailing Address - State:CA
Mailing Address - Zip Code:93532-1012
Mailing Address - Country:US
Mailing Address - Phone:166-172-4238
Mailing Address - Fax:
Practice Address - Street 1:42220 LAKE HUGHES RD
Practice Address - Street 2:
Practice Address - City:LAKE HUGHES
Practice Address - State:CA
Practice Address - Zip Code:93532-1012
Practice Address - Country:US
Practice Address - Phone:166-172-4238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA340981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical