Provider Demographics
NPI:1407672066
Name:VALDEZ, VINCENT CABICO
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:CABICO
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 1:2150 FREELAND RD
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:MD
Mailing Address - Zip Code:21053-9587
Mailing Address - Country:US
Mailing Address - Phone:443-248-5565
Mailing Address - Fax:
Practice Address - Street 1:2150 FREELAND RD
Practice Address - Street 2:
Practice Address - City:FREELAND
Practice Address - State:MD
Practice Address - Zip Code:21053-9587
Practice Address - Country:US
Practice Address - Phone:443-248-5565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-28
Last Update Date:2024-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR231044363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty