Provider Demographics
NPI:1184382822
Name:VALDIVIA, DULCE MARIA
Entity type:Individual
Prefix:
First Name:DULCE
Middle Name:MARIA
Last Name:VALDIVIA
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 1:4827 S MONARCH PL
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-7311
Mailing Address - Country:US
Mailing Address - Phone:323-573-9962
Mailing Address - Fax:
Practice Address - Street 1:4827 S MONARCH PL
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-7311
Practice Address - Country:US
Practice Address - Phone:323-573-9962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician