Provider Demographics
NPI:1568567725
Name:VALDEZ, CARLOS MARIO (DC)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:MARIO
Last Name:VALDEZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 W WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4002
Mailing Address - Country:US
Mailing Address - Phone:323-722-3300
Mailing Address - Fax:323-722-7989
Practice Address - Street 1:1615 W WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4002
Practice Address - Country:US
Practice Address - Phone:323-722-3300
Practice Address - Fax:323-722-7989
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC14520111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAW602AOtherMEDICARE PPTN
CADC14520Medicare ID - Type UnspecifiedMEDICARE ID