Provider Demographics
NPI:1902278823
Name:VALDEZ, KRISTINA (CA)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:CA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 SW WASHINGTON ST
Mailing Address - Street 2:STE 1001
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204
Mailing Address - Country:US
Mailing Address - Phone:503-224-5010
Mailing Address - Fax:503-248-5626
Practice Address - Street 1:319 SW WASHINGTON ST
Practice Address - Street 2:STE 1001
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204
Practice Address - Country:US
Practice Address - Phone:503-224-5010
Practice Address - Fax:503-248-5626
Is Sole Proprietor?:No
Enumeration Date:2015-10-30
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21808225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist