1124069406 NPI number — NORA I VALDES M.D.

Table of content: NORA I VALDES M.D. (NPI 1124069406)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124069406 NPI number — NORA I VALDES M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VALDES
Provider First Name:
NORA
Provider Middle Name:
I
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1124069406
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4903 GOLDEN QUAIL
Provider Second Line Business Mailing Address:
STE 114
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78240-1585
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-614-0000
Provider Business Mailing Address Fax Number:
210-641-2441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5282 MEDICAL DR
Provider Second Line Business Practice Location Address:
SUITE 600
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-6114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-614-0000
Provider Business Practice Location Address Fax Number:
210-614-0372
Provider Enumeration Date:
06/09/2006

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: 207Q00000X , with the licence number:  K9444 , 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)

  • Identifier: 039342302 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7832 . This is a "COMMUNITY FIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10061825 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5342 . This is a "AETNA MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0045KH . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 159973001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 717857 . This is a "UPMC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7517144 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".