Provider Demographics
NPI:1356099303
Name:VALLE, JORGE FRANCISCO JR
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:FRANCISCO
Last Name:VALLE
Suffix:JR
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 1:334 VIA VERA CRUZ STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-2636
Mailing Address - Country:US
Mailing Address - Phone:760-621-9133
Mailing Address - Fax:
Practice Address - Street 1:334 VIA VERA CRUZ STE 102
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-2636
Practice Address - Country:US
Practice Address - Phone:760-621-9133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician