Provider Demographics
NPI:1710246053
Name:RAMOS VALADEZ, DIEGO IVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DIEGO
Middle Name:IVAN
Last Name:RAMOS VALADEZ
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 1:111 COLCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-1473
Mailing Address - Country:US
Mailing Address - Phone:802-847-2700
Mailing Address - Fax:
Practice Address - Street 1:2530 S TELSHOR BLVD STE 103
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4974
Practice Address - Country:US
Practice Address - Phone:575-522-0329
Practice Address - Fax:575-521-3606
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-07
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2020-0636208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX741769336OtherEIN