Provider Demographics
NPI:1629480272
Name:VALDEZ, KRYSTAL ANGELI AQUINO (MD)
Entity Type:Individual
Prefix:
First Name:KRYSTAL ANGELI
Middle Name:AQUINO
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 CASA ST STE 130
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-1887
Mailing Address - Country:US
Mailing Address - Phone:805-541-1422
Mailing Address - Fax:805-595-1815
Practice Address - Street 1:35 CASA ST STE 130
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405
Practice Address - Country:US
Practice Address - Phone:805-541-1422
Practice Address - Fax:805-595-1815
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282N00000X
CAA156854207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No282N00000XHospitalsGeneral Acute Care Hospital