1467637132 NPI number — VICTORIANO VALDEZ M.D. P.A.

Table of content: LADONNE ROBERTA HIGHTOWER BS (NPI 1871066993)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467637132 NPI number — VICTORIANO VALDEZ M.D. P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VICTORIANO VALDEZ M.D. P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1467637132
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAGLE PASS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78853-7130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-773-5000
Provider Business Mailing Address Fax Number:
830-773-6262

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1951 N VETERANS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAGLE PASS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78852-4476
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-773-5000
Provider Business Practice Location Address Fax Number:
830-773-6262
Provider Enumeration Date:
12/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VALDEZ
Authorized Official First Name:
VICTORIANO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
830-773-5000

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 115301701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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