Provider Demographics
NPI:1679678312
Name:VALDEZ, MARIA VERONICA MASILUNGAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA VERONICA
Middle Name:MASILUNGAN
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VERONICA
Other - Middle Name:VALDEZ
Other - Last Name:WISEMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1573 MEDICAL PARK CIR
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-6580
Mailing Address - Country:US
Mailing Address - Phone:662-844-9885
Mailing Address - Fax:662-842-1350
Practice Address - Street 1:1573 MEDICAL PARK CIR
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6580
Practice Address - Country:US
Practice Address - Phone:662-844-9885
Practice Address - Fax:662-842-1350
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13813208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00113994Medicaid
MS00113994Medicaid
MS370000434Medicare ID - Type Unspecified