1164456117 NPI number — DR. JULIE ANN VALDE LOPEZ D.D.S.

Table of content: DR. JULIE ANN VALDE LOPEZ D.D.S. (NPI 1164456117)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164456117 NPI number — DR. JULIE ANN VALDE LOPEZ D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VALDE LOPEZ
Provider First Name:
JULIE ANN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
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:
1164456117
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2814 CAMINO DOS RIOS
Provider Second Line Business Mailing Address:
SUITE #401
Provider Business Mailing Address City Name:
NEWBURY PARK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91320-1134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-499-7676
Provider Business Mailing Address Fax Number:
805-375-8642

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2814 CAMINO DOS RIOS
Provider Second Line Business Practice Location Address:
SUITE #401
Provider Business Practice Location Address City Name:
NEWBURY PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91320-1134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-499-7676
Provider Business Practice Location Address Fax Number:
805-375-8642
Provider Enumeration Date:
07/10/2006

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: 1223G0001X , with the licence number:  43191 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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