Provider Demographics
NPI:1467271007
Name:GRIMALDO, VALERIE
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:GRIMALDO
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 1:5405 BEACH GRASS LN UNIT 137
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-6589
Mailing Address - Country:US
Mailing Address - Phone:909-694-6192
Mailing Address - Fax:
Practice Address - Street 1:5405 BEACH GRASS LN UNIT 137
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-6589
Practice Address - Country:US
Practice Address - Phone:909-694-6192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician