Provider Demographics
NPI:1649726902
Name:VALDIVIA, DAINEL
Entity type:Individual
Prefix:MR
First Name:DAINEL
Middle Name:
Last Name:VALDIVIA
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 1:2850 S MARYLAND PRWY APT N-207
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109
Mailing Address - Country:US
Mailing Address - Phone:702-831-3623
Mailing Address - Fax:
Practice Address - Street 1:2850 S MARYLAND PKWY APT N207
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-1575
Practice Address - Country:US
Practice Address - Phone:702-831-3623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst