Provider Demographics
NPI:1225358419
Name:VALDEZ, JUDILISSA (RN)
Entity Type:Individual
Prefix:
First Name:JUDILISSA
Middle Name:
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W KINGSBRIDGE RD
Mailing Address - Street 2:#6A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-7360
Mailing Address - Country:US
Mailing Address - Phone:917-796-2118
Mailing Address - Fax:
Practice Address - Street 1:201 W KINGSBRIDGE RD APT 6A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-7361
Practice Address - Country:US
Practice Address - Phone:718-432-5440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY614280-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse