Provider Demographics
NPI:1629791694
Name:VALDEZ, ALEXANDRA DENIZ
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:DENIZ
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 CORMIER RD
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-4825
Mailing Address - Country:US
Mailing Address - Phone:920-431-1978
Mailing Address - Fax:
Practice Address - Street 1:1331 BELLEVUE ST LOT 531
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54302-2135
Practice Address - Country:US
Practice Address - Phone:920-489-4514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer