Provider Demographics
NPI:1649421173
Name:VALDEZ MEDICAL MD PA
Entity Type:Organization
Organization Name:VALDEZ MEDICAL MD PA
Other - Org Name:VALDEZ MEDICAL MD PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:NUNEZ
Authorized Official - Last Name:VALDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-742-8485
Mailing Address - Street 1:5809 AIRLINE DR STE C
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77076-4942
Mailing Address - Country:US
Mailing Address - Phone:713-742-8485
Mailing Address - Fax:713-255-5053
Practice Address - Street 1:5809 AIRLINE DR STE C
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77076-4942
Practice Address - Country:US
Practice Address - Phone:713-742-8485
Practice Address - Fax:713-255-5053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9713207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty