Provider Demographics
NPI:1649886136
Name:VALERIO-DYSZKANT, ANDREAS
Entity type:Individual
Prefix:MR
First Name:ANDREAS
Middle Name:
Last Name:VALERIO-DYSZKANT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1877 EL MONTE DR
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-1819
Mailing Address - Country:US
Mailing Address - Phone:310-741-7063
Mailing Address - Fax:
Practice Address - Street 1:1877 EL MONTE DR
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-1819
Practice Address - Country:US
Practice Address - Phone:310-741-7063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-20
Last Update Date:2020-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty