Provider Demographics
NPI:1639512122
Name:VALDEZ, MOISES MANUEL (MD)
Entity type:Individual
Prefix:DR
First Name:MOISES
Middle Name:MANUEL
Last Name:VALDEZ
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:PO BOX 8399
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-8399
Mailing Address - Country:US
Mailing Address - Phone:215-760-9169
Mailing Address - Fax:
Practice Address - Street 1:355 AVE FONT MARTELO
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3249
Practice Address - Country:US
Practice Address - Phone:787-852-0768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2025-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
PR17265-I207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine