Healthcare Provider Details

I. General information

NPI: 1275465171
Provider Name (Legal Business Name): MANUEL HUMBERTO VALDEZ SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4249 N 10TH PL
PHOENIX AZ
85014-4436
US

IV. Provider business mailing address

4249 N 10TH PL
PHOENIX AZ
85014-4436
US

V. Phone/Fax

Practice location:
  • Phone: 602-518-2335
  • Fax:
Mailing address:
  • Phone: 602-518-2335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.026899
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: