Provider Demographics
NPI:1194802876
Name:VALDEZ, JONATHAN
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:
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:PO BOX 2651
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92263-2651
Mailing Address - Country:US
Mailing Address - Phone:760-288-4579
Mailing Address - Fax:
Practice Address - Street 1:19531 MCLANE STREET SUITE B
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262
Practice Address - Country:US
Practice Address - Phone:760-288-4579
Practice Address - Fax:760-288-3752
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator