Healthcare Provider Details

I. General information

NPI: 1083131742
Provider Name (Legal Business Name): MAREL R VALDEZ X
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PINE AVE STE 400
LONG BEACH CA
90802-3039
US

IV. Provider business mailing address

200 PINE AVE STE 400
LONG BEACH CA
90802-3039
US

V. Phone/Fax

Practice location:
  • Phone: 661-569-5100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number539032
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number539032
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: