Provider Demographics
NPI:1912194184
Name:VALDIVIA, NORMA (R1191840115)
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:
Last Name:VALDIVIA
Suffix:
Gender:F
Credentials:R1191840115
Other - Prefix:
Other - First Name:NORMA
Other - Middle Name:HERRERA
Other - Last Name:VALDIVIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11001 UNION AVENUE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93307
Mailing Address - Country:US
Mailing Address - Phone:661-861-6111
Mailing Address - Fax:
Practice Address - Street 1:1100 UNION AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93307-1051
Practice Address - Country:US
Practice Address - Phone:661-861-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1191840115101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)