Provider Demographics
NPI:1851339360
Name:VALDES, ZIDRIECK PARDUCHO (MD)
Entity Type:Individual
Prefix:DR
First Name:ZIDRIECK
Middle Name:PARDUCHO
Last Name:VALDES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26145
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89126-0145
Mailing Address - Country:US
Mailing Address - Phone:702-877-8808
Mailing Address - Fax:702-877-8889
Practice Address - Street 1:1019 S DECATUR BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-3920
Practice Address - Country:US
Practice Address - Phone:702-877-8808
Practice Address - Fax:702-877-8889
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8355207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002019946Medicaid