Provider Demographics
NPI:1831884667
Name:VALADEZ, JORGE
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:VALADEZ
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 1:3088 W ASHLAN AVE APT 134
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-4510
Mailing Address - Country:US
Mailing Address - Phone:559-290-6750
Mailing Address - Fax:
Practice Address - Street 1:3475 W SHAW AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3200
Practice Address - Country:US
Practice Address - Phone:559-271-1186
Practice Address - Fax:559-271-8041
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB94025369103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist