Provider Demographics
NPI:1912391632
Name:URREGO-VALLOWE, VICTOR (LCSW)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:URREGO-VALLOWE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:VICTOR
Other - Middle Name:
Other - Last Name:URREGO-VALLOWE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:3808 AUBURN BLVD STE 46
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-2122
Mailing Address - Country:US
Mailing Address - Phone:916-256-7107
Mailing Address - Fax:916-251-1148
Practice Address - Street 1:3808 AUBURN BLVD STE 46
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-2122
Practice Address - Country:US
Practice Address - Phone:916-256-7107
Practice Address - Fax:916-251-1148
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-19
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW873981041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA100192313Medicaid