Provider Demographics
NPI:1124053012
Name:VALDEZ, AMELIA BAUTISTA (MD)
Entity type:Individual
Prefix:DR
First Name:AMELIA
Middle Name:BAUTISTA
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 TENNESSEE ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-4450
Mailing Address - Country:US
Mailing Address - Phone:707-554-1986
Mailing Address - Fax:707-554-1987
Practice Address - Street 1:329 TENNESSEE ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-4450
Practice Address - Country:US
Practice Address - Phone:707-554-1986
Practice Address - Fax:707-554-1987
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA526260207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A526260Medicare ID - Type Unspecified
CAF47955Medicare UPIN