Provider Demographics
NPI:1720355407
Name:VALDOVINOS, MARIA A (CASE MANAGER)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:A
Last Name:VALDOVINOS
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2677 ZOE AVE STE 114
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-6995
Mailing Address - Country:US
Mailing Address - Phone:323-923-9559
Mailing Address - Fax:323-923-9566
Practice Address - Street 1:2677 ZOE AVE STE 114
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-6995
Practice Address - Country:US
Practice Address - Phone:323-923-9559
Practice Address - Fax:323-923-9566
Is Sole Proprietor?:No
Enumeration Date:2011-11-22
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW71859101YM0800X
171M00000X
CALCSW931851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator