Provider Demographics
NPI:1932592045
Name:VALDEZ, MICHAEL NIKKO ACOSTA
Entity Type:Individual
Prefix:MR
First Name:MICHAEL NIKKO
Middle Name:ACOSTA
Last Name:VALDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10022 SE 172ND AVE
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-9630
Mailing Address - Country:US
Mailing Address - Phone:561-251-8632
Mailing Address - Fax:
Practice Address - Street 1:10022 SE 172ND AVE
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-9630
Practice Address - Country:US
Practice Address - Phone:561-251-8632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-13
Last Update Date:2021-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist