Provider Demographics
NPI:1740699057
Name:VALENTINE, OLGA
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:VALENTINE
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 1:2250 DEKAY AVE BLDG 317
Mailing Address - Street 2:
Mailing Address - City:MARCH ARB
Mailing Address - State:CA
Mailing Address - Zip Code:92518-1667
Mailing Address - Country:US
Mailing Address - Phone:951-655-5097
Mailing Address - Fax:
Practice Address - Street 1:2250 DEKAY AVE
Practice Address - Street 2:
Practice Address - City:MARCH ARB
Practice Address - State:CA
Practice Address - Zip Code:92518-1667
Practice Address - Country:US
Practice Address - Phone:951-655-5097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 132931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical