Provider Demographics
NPI:1972808624
Name:VALDEZ, RICHARD (BSBA)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:VALDEZ
Suffix:
Gender:M
Credentials:BSBA
Other - Prefix:
Other - First Name:DICK
Other - Middle Name:
Other - Last Name:VALDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:284 W 1825 N
Mailing Address - Street 2:
Mailing Address - City:NORTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84414-7320
Mailing Address - Country:US
Mailing Address - Phone:801-458-2320
Mailing Address - Fax:801-393-5953
Practice Address - Street 1:284 W 1825 N
Practice Address - Street 2:
Practice Address - City:NORTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84414-7320
Practice Address - Country:US
Practice Address - Phone:801-458-2320
Practice Address - Fax:801-393-5953
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility