Provider Demographics
NPI:1730218405
Name:VALDEZ MEDICAL CORP
Entity type:Organization
Organization Name:VALDEZ MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:VALDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-756-1214
Mailing Address - Street 1:1850 SULLIVAN AVE STE 420
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2204
Mailing Address - Country:US
Mailing Address - Phone:650-756-1214
Mailing Address - Fax:650-756-3579
Practice Address - Street 1:1850 SULLIVAN AVE STE 420
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2204
Practice Address - Country:US
Practice Address - Phone:650-756-1214
Practice Address - Fax:650-756-3579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52626207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1124053012OtherINDIVIDUAL NPI(TYPE I)
CAA526260Medicare ID - Type UnspecifiedMEDICARE #
CAF47955Medicare UPIN