1477921369 NPI number — LUIS GERARDO VALDEZ

Table of content: (NPI 1477921369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477921369 NPI number — LUIS GERARDO VALDEZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUIS GERARDO VALDEZ
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:
1477921369
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CALLE COAHUILA #223
Provider Second Line Business Mailing Address:
SUITE 9B
Provider Business Mailing Address City Name:
NUEVO PROGRESO
Provider Business Mailing Address State Name:
TAMAULIPAS
Provider Business Mailing Address Postal Code:
88810
Provider Business Mailing Address Country Code:
MX
Provider Business Mailing Address Telephone Number:
956-279-4009
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE COAHUILA #223
Provider Second Line Business Practice Location Address:
SUITE 9B
Provider Business Practice Location Address City Name:
NUEVO PROGRESO
Provider Business Practice Location Address State Name:
TAMAULIPAS
Provider Business Practice Location Address Postal Code:
88810
Provider Business Practice Location Address Country Code:
MX
Provider Business Practice Location Address Telephone Number:
956-279-4009
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/09/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VALDEZ
Authorized Official First Name:
LUIS
Authorized Official Middle Name:
GERARDO
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
956-279-4009

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  928023 , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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