Provider Demographics
NPI:1396964516
Name:VALDES, MAURICIO (MD)
Entity type:Individual
Prefix:
First Name:MAURICIO
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 1:1492 S MILL AVE STE 113
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-5660
Mailing Address - Country:US
Mailing Address - Phone:602-553-3113
Mailing Address - Fax:602-667-7991
Practice Address - Street 1:1492 S MILL AVE STE 113
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-5660
Practice Address - Country:US
Practice Address - Phone:602-553-3113
Practice Address - Fax:602-667-7991
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP00427207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery