1932181971 NPI number — NANCY VALDEZ M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932181971 NPI number — NANCY VALDEZ M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

VALDEZ

Provider First Name:

NANCY

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

F

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:

1932181971

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/07/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

823 GATEWAY CENTER WAY

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

SAN DIEGO

Provider Business Mailing Address State Name:

CA

Provider Business Mailing Address Postal Code:

92102-4541

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

619-515-2300

Provider Business Mailing Address Fax Number:

619-269-0674

Provider First Line Business Practice Location Address:

307 54TH ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

LUBBOCK

Provider Business Practice Location Address State Name:

TX

Provider Business Practice Location Address Postal Code:

79404

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

806-438-8005

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

11/16/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208000000X , with the licence number:  C164884 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 208000000X , with the licence number: L5161 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 10125740 . This is a "DPS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 152992702 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 86911Z . This is a "HMO BLUE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 152992701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 131327101 . This is a "FIRSTCARE COMMERCIAL" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: A542 . This is a "TRIWEST" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
• Identifier: 131327100 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 48286541 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
• Identifier: 8G6050 . This is a "BC/BS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 100146850A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".