Provider Demographics
NPI:1295836773
Name:VALDEZ-MAGUIRE, GRACIELA (NP)
Entity Type:Individual
Prefix:MRS
First Name:GRACIELA
Middle Name:
Last Name:VALDEZ-MAGUIRE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 E COLORADO BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-5860
Mailing Address - Country:US
Mailing Address - Phone:626-229-9865
Mailing Address - Fax:626-229-9867
Practice Address - Street 1:2100 E COLORADO BLVD STE 1
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107
Practice Address - Country:US
Practice Address - Phone:626-229-9865
Practice Address - Fax:626-229-9867
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA458977363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHL102ZMedicare PIN