Provider Demographics
NPI:1194494971
Name:VALDEZ ESPINOZA, IAM POOL
Entity type:Individual
Prefix:
First Name:IAM
Middle Name:POOL
Last Name:VALDEZ ESPINOZA
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 1:124 GRAYSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:MAUSTON
Mailing Address - State:WI
Mailing Address - Zip Code:53948-1913
Mailing Address - Country:US
Mailing Address - Phone:608-847-7575
Mailing Address - Fax:
Practice Address - Street 1:124 GRAYSIDE AVE
Practice Address - Street 2:
Practice Address - City:MAUSTON
Practice Address - State:WI
Practice Address - Zip Code:53948-1913
Practice Address - Country:US
Practice Address - Phone:608-847-5575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty