Healthcare Provider Details

I. General information

NPI: 1205579117
Provider Name (Legal Business Name): JUAN ANTONIO VALADEZ DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2022
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18040 SHERMAN WAY STE 200
RESEDA CA
91335-4656
US

IV. Provider business mailing address

10565 CIVIC CENTER DR STE 250
RANCHO CUCAMONGA CA
91730-3854
US

V. Phone/Fax

Practice location:
  • Phone: 818-212-2223
  • Fax: 818-212-2224
Mailing address:
  • Phone:
  • Fax: 626-696-1451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number20A20965
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number20A20965
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: