Healthcare Provider Details

I. General information

NPI: 1427584986
Provider Name (Legal Business Name): MARIA TAMARA VALDEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIA TAMARA WELLNER RN

II. Dates (important events)

Enumeration Date: 05/03/2017
Last Update Date: 05/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4930 DEL MAR AVE UNIT 105
SAN DIEGO CA
92107-3424
US

IV. Provider business mailing address

4930 DEL MAR AVE UNIT 105
SAN DIEGO CA
92107-3424
US

V. Phone/Fax

Practice location:
  • Phone: 217-816-1043
  • Fax:
Mailing address:
  • Phone: 217-816-1043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN1003X
TaxonomyNutrition Support Registered Nurse
License Number725173
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: