Provider Demographics
NPI:1679504054
Name:VALDIVIA, ENRIQUE ARTURO (MD)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:ARTURO
Last Name:VALDIVIA
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 1:20100 N 51ST AVE
Mailing Address - Street 2:SUITE F620
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-5125
Mailing Address - Country:US
Mailing Address - Phone:623-376-6328
Mailing Address - Fax:623-566-6454
Practice Address - Street 1:20100 N 51ST AVE
Practice Address - Street 2:SUITE F620
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-5084
Practice Address - Country:US
Practice Address - Phone:623-376-6328
Practice Address - Fax:623-566-6454
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35590174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH79126Medicare UPIN