Provider Demographics
NPI:1699367839
Name:VALENZUELA, JENNIFER JOY
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JOY
Last Name:VALENZUELA
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 1:2250 W MILL ST SPC 2
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-1049
Mailing Address - Country:US
Mailing Address - Phone:909-868-8342
Mailing Address - Fax:
Practice Address - Street 1:5838 TOSCANA TRCE
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-4402
Practice Address - Country:US
Practice Address - Phone:916-869-2416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0000000000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health