Provider Demographics
NPI:1962286484
Name:VALDEZ, EDGAR ISRAEL
Entity type:Individual
Prefix:MR
First Name:EDGAR
Middle Name:ISRAEL
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 1:11151 BONWOOD RD APT 3
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91733-2855
Mailing Address - Country:US
Mailing Address - Phone:626-322-6181
Mailing Address - Fax:
Practice Address - Street 1:11151 BONWOOD RD APT 3
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-2855
Practice Address - Country:US
Practice Address - Phone:626-322-6181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer