Provider Demographics
NPI:1578166302
Name:VALDEZ, ADELE (LVN)
Entity Type:Individual
Prefix:PROF
First Name:ADELE
Middle Name:
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 N BLACKSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93701-1913
Mailing Address - Country:US
Mailing Address - Phone:559-274-0299
Mailing Address - Fax:844-606-7326
Practice Address - Street 1:258 N BLACKSTONE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-1913
Practice Address - Country:US
Practice Address - Phone:559-274-0299
Practice Address - Fax:844-606-7326
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN213923164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty