Provider Demographics
NPI:1841415510
Name:VALENCIA, JOAQUIN ANIBAL
Entity Type:Individual
Prefix:
First Name:JOAQUIN
Middle Name:ANIBAL
Last Name:VALENCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 CODDINGTOWN CTR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-3537
Mailing Address - Country:US
Mailing Address - Phone:707-565-7656
Mailing Address - Fax:
Practice Address - Street 1:1300 CODDINGTOWN CTR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-3537
Practice Address - Country:US
Practice Address - Phone:707-565-7656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)