Healthcare Provider Details

I. General information

NPI: 1184880528
Provider Name (Legal Business Name): REDEL DIONISIO IGLES VALERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2008
Last Update Date: 03/25/2022
Certification Date: 03/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 HERNDON AVE
CLOVIS CA
93611-6800
US

IV. Provider business mailing address

45 E RIVER PARK PL W STE 507
FRESNO CA
93720-1565
US

V. Phone/Fax

Practice location:
  • Phone: 559-324-4000
  • Fax:
Mailing address:
  • Phone: 559-603-7327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11014613A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2011014312
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberC145763
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: