Provider Demographics
NPI:1043062961
Name:VALDES, VICTORIA MARIE (CNM)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MARIE
Last Name:VALDES
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 SE RURAL ST APT 473
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-5863
Mailing Address - Country:US
Mailing Address - Phone:626-905-0121
Mailing Address - Fax:
Practice Address - Street 1:14411 SE MCLOUGHLIN BLVD
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267-1412
Practice Address - Country:US
Practice Address - Phone:888-875-7820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10024401367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife