Provider Demographics
NPI:1265534580
Name:VALDES, IGNACIO (MD)
Entity type:Individual
Prefix:DR
First Name:IGNACIO
Middle Name:
Last Name:VALDES
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 1:222 W EULALIA ST
Mailing Address - Street 2:STE 211
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2849
Mailing Address - Country:US
Mailing Address - Phone:818-502-4567
Mailing Address - Fax:818-502-4568
Practice Address - Street 1:222 W EULALIA ST
Practice Address - Street 2:STE 211
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2849
Practice Address - Country:US
Practice Address - Phone:818-502-4567
Practice Address - Fax:818-502-4568
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG062465207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G624650Medicaid
CAF08414Medicare UPIN
CA00G624650Medicaid