Provider Demographics
NPI:1356004733
Name:VALDEZ, ANGELICA MONIQUE
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:MONIQUE
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2433 BAY ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-2711
Mailing Address - Country:US
Mailing Address - Phone:661-742-6424
Mailing Address - Fax:
Practice Address - Street 1:8000 WHITE LN
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-7688
Practice Address - Country:US
Practice Address - Phone:661-837-2198
Practice Address - Fax:661-837-1262
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA91274183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician