Provider Demographics
NPI:1609814409
Name:VALDEZ, REYNALDO (PNP)
Entity Type:Individual
Prefix:
First Name:REYNALDO
Middle Name:
Last Name:VALDEZ
Suffix:
Gender:M
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 E DURANTA AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ALAMO
Mailing Address - State:TX
Mailing Address - Zip Code:78516-3406
Mailing Address - Country:US
Mailing Address - Phone:956-702-2444
Mailing Address - Fax:956-702-2455
Practice Address - Street 1:427 E DURANTA AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:ALAMO
Practice Address - State:TX
Practice Address - Zip Code:78516-3406
Practice Address - Country:US
Practice Address - Phone:956-702-2444
Practice Address - Fax:956-702-2455
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX518435363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111485205Medicaid
TX111485207Medicaid
TX111485206Medicaid
TX111485204Medicaid
TX111485208Medicaid