Provider Demographics
NPI:1760983415
Name:VALDEZ GUZMAN, ALEJANDRA MARIVEL
Entity Type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:MARIVEL
Last Name:VALDEZ GUZMAN
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 1:17070 WALNUT VILLAGE PKWY STE K
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-3285
Mailing Address - Country:US
Mailing Address - Phone:909-320-8300
Mailing Address - Fax:
Practice Address - Street 1:8955 LIME CT
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-4424
Practice Address - Country:US
Practice Address - Phone:909-275-8506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA90479470D84149OtherIEHP