Healthcare Provider Details

I. General information

NPI: 1144221839
Provider Name (Legal Business Name): JESUS M VALADEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 08/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31001 RANCHO VIEJO RD STE 200
SAN JUAN CAPISTRANO CA
92675
US

IV. Provider business mailing address

31001 RANCHO VIEJO RD STE 200
SAN JUAN CAPISTRANO CA
92675-8704
US

V. Phone/Fax

Practice location:
  • Phone: 949-661-9600
  • Fax: 949-443-6200
Mailing address:
  • Phone: 949-661-9600
  • Fax: 949-443-6200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA64307
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: