Provider Demographics
NPI:1972545994
Name:VALLES, JOHN PEDUCA (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PEDUCA
Last Name:VALLES
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 1:9653 MESA RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-7818
Mailing Address - Country:US
Mailing Address - Phone:702-232-4210
Mailing Address - Fax:702-453-7005
Practice Address - Street 1:9653 MESA RIDGE CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7818
Practice Address - Country:US
Practice Address - Phone:702-232-4210
Practice Address - Fax:702-453-7005
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV107102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV104918OtherMEDICARE PTAN
NV100505673Medicaid
NVCS12434OtherCS
NVCS12434OtherCS
NVCS12434OtherCS