Provider Demographics
NPI:1194438739
Name:VALDEZ, CHARLOTTE (LMT)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 AIRLINE RD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-2641
Mailing Address - Country:US
Mailing Address - Phone:361-765-7278
Mailing Address - Fax:
Practice Address - Street 1:2101 AIRLINE RD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-2641
Practice Address - Country:US
Practice Address - Phone:361-765-7278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX014802225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist