Provider Demographics
NPI:1629269329
Name:MARIO P. VALDEZ, M.D., P.C.
Entity Type:Organization
Organization Name:MARIO P. VALDEZ, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:P
Authorized Official - Last Name:VALDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-889-9694
Mailing Address - Street 1:P.O. BOX 37073
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85740
Mailing Address - Country:US
Mailing Address - Phone:520-889-9694
Mailing Address - Fax:520-889-9233
Practice Address - Street 1:4609 S. 12TH AVENUE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85740
Practice Address - Country:US
Practice Address - Phone:520-889-9694
Practice Address - Fax:520-889-9322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5399207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty