Provider Demographics
NPI:1659842714
Name:VALDEZ, MEDIE PIZARRO
Entity Type:Individual
Prefix:
First Name:MEDIE
Middle Name:PIZARRO
Last Name:VALDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1992 N KENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-4942
Mailing Address - Country:US
Mailing Address - Phone:415-635-9239
Mailing Address - Fax:
Practice Address - Street 1:1992 N KENWOOD AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-4942
Practice Address - Country:US
Practice Address - Phone:951-215-9502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)