1013334523 NPI number — BERNADETTE VALDEZ PT

Table of content: BERNADETTE VALDEZ PT (NPI 1013334523)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013334523 NPI number — BERNADETTE VALDEZ PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VALDEZ
Provider First Name:
BERNADETTE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FRIGERIO
Provider Other First Name:
BERNADETTE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1013334523
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 640
Provider Second Line Business Mailing Address:
ISLETA HEATH CENTER
Provider Business Mailing Address City Name:
ISLETA
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87022-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-869-4866
Provider Business Mailing Address Fax Number:
505-869-4881

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
01 SAGE BRUSH ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ISLETA
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87022-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-869-4398
Provider Business Practice Location Address Fax Number:
505-869-4881
Provider Enumeration Date:
03/21/2014

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: 225100000X , with the licence number:  4405 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4405 . This is a "LICENSE" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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