Provider Demographics
NPI:1306371182
Name:VALADEZ, ZACHARY GRANT (MD)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:GRANT
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 1:1901 TOWN AND COUNTRY DR STE 104
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-3611
Mailing Address - Country:US
Mailing Address - Phone:951-808-6240
Mailing Address - Fax:
Practice Address - Street 1:2250 S MAIN ST STE 106
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-2501
Practice Address - Country:US
Practice Address - Phone:951-371-2703
Practice Address - Fax:951-371-9348
Is Sole Proprietor?:No
Enumeration Date:2017-04-28
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA169478207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine