Provider Demographics
NPI:1568294338
Name:VALDEZ, SHIRLEY C (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:C
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14029 HIGHLANDER RD
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-6601
Mailing Address - Country:US
Mailing Address - Phone:562-640-2399
Mailing Address - Fax:
Practice Address - Street 1:14029 HIGHLANDER RD
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-6601
Practice Address - Country:US
Practice Address - Phone:562-640-2399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95031540363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily