Provider Demographics
NPI:1972642239
Name:VALERO FONSECA, JAVIER (MD)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:
Last Name:VALERO FONSECA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAVIER
Other - Middle Name:
Other - Last Name:VALERO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1524 MCHENRY AVE STE 570
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4574
Mailing Address - Country:US
Mailing Address - Phone:209-572-3880
Mailing Address - Fax:209-572-3349
Practice Address - Street 1:1524 MCHENRY AVE STE 570
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4574
Practice Address - Country:US
Practice Address - Phone:209-572-3880
Practice Address - Fax:209-572-3349
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC153203208000000X, 2084N0400X
TN45505208000000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics