Healthcare Provider Details

I. General information

NPI: 1568580835
Provider Name (Legal Business Name): CONSUELO N VALDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 ROSECRANS ST
SAN DIEGO CA
92110-3115
US

IV. Provider business mailing address

620 N HICKORY ST UNIT 1
ESCONDIDO CA
92025-6900
US

V. Phone/Fax

Practice location:
  • Phone: 760-855-4068
  • Fax:
Mailing address:
  • Phone: 760-233-0055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: