Provider Demographics
NPI:1427584986
Name:VALDEZ, MARIA TAMARA (RN)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:TAMARA
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:MARIA
Other - Middle Name:TAMARA
Other - Last Name:WELLNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:4930 DEL MAR AVE
Mailing Address - Street 2:UNIT 105
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-3424
Mailing Address - Country:US
Mailing Address - Phone:217-816-1043
Mailing Address - Fax:
Practice Address - Street 1:4930 DEL MAR AVE
Practice Address - Street 2:UNIT 105
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92107-3424
Practice Address - Country:US
Practice Address - Phone:217-816-1043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA725173163WN1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN1003XNursing Service ProvidersRegistered NurseNutrition Support