Provider Demographics
NPI:1255035655
Name:VIRIDIANA VALDEZ MACIAS
Entity type:Organization
Organization Name:VIRIDIANA VALDEZ MACIAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIRIDIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:VALDEZ MACIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-349-6409
Mailing Address - Street 1:1266 12TH STREET
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:91932
Mailing Address - Country:US
Mailing Address - Phone:664-375-0343
Mailing Address - Fax:619-354-2449
Practice Address - Street 1:CALLE VILLASANA #601
Practice Address - Street 2:COL. ANEXA 20 DE NOVIEMBRE
Practice Address - City:TIJUANA
Practice Address - State:BAJA CALIFORNIA
Practice Address - Zip Code:22100
Practice Address - Country:MX
Practice Address - Phone:664-375-0343
Practice Address - Fax:619-354-2449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty