Provider Demographics
NPI:1942601117
Name:VALES, JONATHAN BYRON
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:BYRON
Last Name:VALES
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JON
Other - Middle Name:B
Other - Last Name:VALES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:233 S QUINTANA DR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-4029
Mailing Address - Country:US
Mailing Address - Phone:714-881-8600
Mailing Address - Fax:
Practice Address - Street 1:233 S QUINTANA DR
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-4029
Practice Address - Country:US
Practice Address - Phone:714-881-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CA66813101YM0800X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health