Provider Demographics
NPI:1144221839
Name:VALADEZ, JESUS M (MD)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:M
Last Name:VALADEZ
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 1:31001 RANCHO VIEJO RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-8704
Mailing Address - Country:US
Mailing Address - Phone:949-661-9600
Mailing Address - Fax:949-443-6200
Practice Address - Street 1:31001 RANCHO VIEJO RD STE 200
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675
Practice Address - Country:US
Practice Address - Phone:949-661-9600
Practice Address - Fax:949-443-6200
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64307207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A643070OtherMEDI CAL
CA00A643070OtherMEDI CAL