Basic Information
| Provider Information | |||||||||
| NPI: | 1881919561 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VALDIVIA | ||||||||
| FirstName: | JULIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 ALAMEDA DE LAS PULGAS | ||||||||
| Address2: | |||||||||
| City: | SAN MATEO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 944031269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6505732581 | ||||||||
| FaxNumber: | 6503417389 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 ALAMEDA DE LAS PULGAS | ||||||||
| Address2: | |||||||||
| City: | SAN MATEO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 944031269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6505732581 | ||||||||
| FaxNumber: | 6503417389 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2010 | ||||||||
| LastUpdateDate: | 04/06/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 172V00000X | Y | Other Service Providers | Community Health Worker |
No ID Information.