1114243029 NPI number — MR. JAN ALFRED BALINO VALDES MA, MFT

Table of content: MR. JAN ALFRED BALINO VALDES MA, MFT (NPI 1114243029)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114243029 NPI number — MR. JAN ALFRED BALINO VALDES MA, MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VALDES
Provider First Name:
JAN ALFRED
Provider Middle Name:
BALINO
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MA, MFT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114243029
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 262561
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92196-2561
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-535-0085
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9051 MIRA MESA BLVD
Provider Second Line Business Practice Location Address:
262561
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-535-0085
Provider Business Practice Location Address Fax Number:
844-273-4070
Provider Enumeration Date:
04/16/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  101103 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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