Provider Demographics
NPI:1427571868
Name:VALADEZ, TINA M
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:VALADEZ
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 1:309 E MOUNTAIN VIEW ST
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-2897
Mailing Address - Country:US
Mailing Address - Phone:760-256-7279
Mailing Address - Fax:
Practice Address - Street 1:309 E MOUNTAIN VIEW ST
Practice Address - Street 2:
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-2897
Practice Address - Country:US
Practice Address - Phone:760-256-7279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist