Provider Demographics
NPI:1811283054
Name:EDWARD JAMES VALDEZ
Entity type:Organization
Organization Name:EDWARD JAMES VALDEZ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:VALDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-351-1862
Mailing Address - Street 1:8888 DYER ST STE 102
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79904-2034
Mailing Address - Country:US
Mailing Address - Phone:915-351-1862
Mailing Address - Fax:915-260-5992
Practice Address - Street 1:8888 DYER ST STE 102
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79904
Practice Address - Country:US
Practice Address - Phone:915-351-1862
Practice Address - Fax:915-260-5992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-27
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX295779702Medicaid