Provider Demographics
NPI:1710172788
Name:VALDERAS, EDITH
Entity Type:Individual
Prefix:MRS
First Name:EDITH
Middle Name:
Last Name:VALDERAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11800 W THOMPSON RANCH RD
Mailing Address - Street 2:
Mailing Address - City:EL MIRAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85335-3208
Mailing Address - Country:US
Mailing Address - Phone:623-523-8400
Mailing Address - Fax:
Practice Address - Street 1:11800 W THOMPSON RANCH RD
Practice Address - Street 2:
Practice Address - City:EL MIRAGE
Practice Address - State:AZ
Practice Address - Zip Code:85335-3208
Practice Address - Country:US
Practice Address - Phone:623-523-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207021164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse