Provider Demographics
NPI:1336628205
Name:VALDEZ, VIVIAN (PSYD)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:VIVIAN
Other - Middle Name:
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:10323 SANTA MONICA BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5056
Mailing Address - Country:US
Mailing Address - Phone:510-333-4595
Mailing Address - Fax:
Practice Address - Street 1:10323 SANTA MONICA BLVD STE 111
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5056
Practice Address - Country:US
Practice Address - Phone:510-333-4595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist