Healthcare Provider Details

I. General information

NPI: 1972642239
Provider Name (Legal Business Name): JAVIER VALERO FONSECA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JAVIER VALERO M.D.

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 02/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 MCHENRY AVE STE 570
MODESTO CA
95350-4574
US

IV. Provider business mailing address

1524 MCHENRY AVE STE 570
MODESTO CA
95350-4574
US

V. Phone/Fax

Practice location:
  • Phone: 209-572-3880
  • Fax: 209-572-3349
Mailing address:
  • Phone: 209-572-3880
  • Fax: 209-572-3349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC153203
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number45505
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number45505
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberC153203
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: