Provider Demographics
NPI:1588633762
Name:VALDEZ, VINCENT J (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:J
Last Name:VALDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8067 FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-3816
Mailing Address - Country:US
Mailing Address - Phone:562-622-0095
Mailing Address - Fax:562-622-0087
Practice Address - Street 1:8067 FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-3816
Practice Address - Country:US
Practice Address - Phone:562-622-0095
Practice Address - Fax:562-622-0087
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG57943208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A93497Medicare UPIN
A93497Medicare UPIN
WG57943CMedicare ID - Type Unspecified