Healthcare Provider Details

I. General information

NPI: 1508485087
Provider Name (Legal Business Name): NATHANIA A VALDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2020
Last Update Date: 04/14/2020
Certification Date: 04/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4175 SOUTH ALAMO AVE
TUCSON AZ
85707
US

IV. Provider business mailing address

5020 E ARIZOLA ST
DAVIS MONTHAN AFB AZ
85707
US

V. Phone/Fax

Practice location:
  • Phone: 520-228-2778
  • Fax:
Mailing address:
  • Phone: 520-228-7812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: