Provider Demographics
NPI:1417583865
Name:VALDEZ, JESUS MANUEL (LVN)
Entity Type:Individual
Prefix:MR
First Name:JESUS
Middle Name:MANUEL
Last Name:VALDEZ
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12850 BRET HARTE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79928-5150
Mailing Address - Country:US
Mailing Address - Phone:915-803-1388
Mailing Address - Fax:
Practice Address - Street 1:12850 BRET HARTE DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79928-5150
Practice Address - Country:US
Practice Address - Phone:915-803-1388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX352904164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse