Provider Demographics
NPI:1669986303
Name:VALDES GONZALEZ, ALICIA (CSA)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:VALDES GONZALEZ
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 HAYES RD APT 6914
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-6943
Mailing Address - Country:US
Mailing Address - Phone:979-330-8319
Mailing Address - Fax:
Practice Address - Street 1:29310 PRAIRIE ROSE CT
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-7384
Practice Address - Country:US
Practice Address - Phone:786-556-8819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-16
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17363246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
17363OtherUNITED, AETNA, CIGNA, BLUE CROSS AND BLUE SHIELD