Provider Demographics
NPI:1144369240
Name:VALDILLEZ, ADRIANA
Entity type:Individual
Prefix:MISS
First Name:ADRIANA
Middle Name:
Last Name:VALDILLEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-1945
Mailing Address - Country:US
Mailing Address - Phone:909-331-9753
Mailing Address - Fax:
Practice Address - Street 1:360 E 7TH ST
Practice Address - Street 2:SUITE F
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-6701
Practice Address - Country:US
Practice Address - Phone:909-985-6613
Practice Address - Fax:909-985-9087
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57091183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician