Provider Demographics
NPI:1245365303
Name:VALDIVIEZ, DANIEL ROBERT (BA)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:ROBERT
Last Name:VALDIVIEZ
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 W 101ST PL
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80260-6221
Mailing Address - Country:US
Mailing Address - Phone:916-627-0225
Mailing Address - Fax:
Practice Address - Street 1:1455 BEELER ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80010-3027
Practice Address - Country:US
Practice Address - Phone:303-360-6014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health