Provider Demographics
NPI:1639512122
Name:VALDEZ, MOISES MANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MOISES
Middle Name:MANUEL
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 1:13354 SUSAN TER APT SUITE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-1165
Mailing Address - Country:US
Mailing Address - Phone:215-303-8169
Mailing Address - Fax:
Practice Address - Street 1:4519 N 5TH ST APT SUITE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-2309
Practice Address - Country:US
Practice Address - Phone:215-457-1620
Practice Address - Fax:215-457-0350
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health