1093046450 NPI number — MR. JAMES EDWARD VALDEZ SR. L.C.D.C.-I

Table of content: MR. JAMES EDWARD VALDEZ SR. L.C.D.C.-I (NPI 1093046450)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093046450 NPI number — MR. JAMES EDWARD VALDEZ SR. L.C.D.C.-I

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VALDEZ
Provider First Name:
JAMES
Provider Middle Name:
EDWARD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
L.C.D.C.-I
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:
1093046450
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 MEADOWVIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYTLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78052-3605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-286-8116
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1010 W HONDO AVE BLDG 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEVINE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78016-1921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-663-9786
Provider Business Practice Location Address Fax Number:
830-663-9800
Provider Enumeration Date:
01/26/2010

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: 101YA0400X , with the licence number:  101YA0400X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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