Provider Demographics
NPI:1952510034
Name:CELIS VALDIVIEZO, EDUARDO ARTURO (MD)
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:ARTURO
Last Name:CELIS VALDIVIEZO
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 1:788 8TH AVE SE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52401-2107
Mailing Address - Country:US
Mailing Address - Phone:319-221-8788
Mailing Address - Fax:319-221-8787
Practice Address - Street 1:12902 USF MAGNOLIA DR
Practice Address - Street 2:CSB 1162
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-9416
Practice Address - Country:US
Practice Address - Phone:813-745-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301087589207R00000X
IA40605207R00000X
FL146537207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine