Healthcare Provider Details

I. General information

NPI: 1417590548
Provider Name (Legal Business Name): KERI DENISE VALDEZ MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2019
Last Update Date: 10/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 W COLE BLVD
CALEXICO CA
92231-9722
US

IV. Provider business mailing address

462 S SANTA ROSA AVE
EL CENTRO CA
92243-5563
US

V. Phone/Fax

Practice location:
  • Phone: 760-554-4828
  • Fax:
Mailing address:
  • Phone: 760-554-4828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number95013090
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: