Provider Demographics
NPI:1386607174
Name:VALDEZ, JOSE L (MD)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:L
Last Name:VALDEZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2192 N GRANDVIEW RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-6402
Mailing Address - Country:US
Mailing Address - Phone:714-974-2720
Mailing Address - Fax:
Practice Address - Street 1:1125 E 17TH ST
Practice Address - Street 2:STE E-224
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-2201
Practice Address - Country:US
Practice Address - Phone:714-547-0634
Practice Address - Fax:714-547-9920
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA45658207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A456580Medicaid
CAF18080Medicare UPIN
CAA45658Medicare ID - Type Unspecified