Provider Demographics
NPI:1689076374
Name:VALDEZ, MONICA ADRIANA (IDC)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:ADRIANA
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5978 ROANOKE ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92139-3125
Mailing Address - Country:US
Mailing Address - Phone:619-384-8954
Mailing Address - Fax:
Practice Address - Street 1:5978 ROANOKE ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92139-3125
Practice Address - Country:US
Practice Address - Phone:619-384-8954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman