Provider Demographics
NPI:1053327866
Name:VALDES, OSCAR C (MD)
Entity Type:Individual
Prefix:
First Name:OSCAR
Middle Name:C
Last Name:VALDES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 N SAN GABRIEL BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3426
Mailing Address - Country:US
Mailing Address - Phone:626-795-5404
Mailing Address - Fax:626-795-5407
Practice Address - Street 1:180 N SAN GABRIEL BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3426
Practice Address - Country:US
Practice Address - Phone:626-795-5404
Practice Address - Fax:626-795-5407
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC396962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
A88125Medicare UPIN
CAC39696CMedicare ID - Type Unspecified