Healthcare Provider Details

I. General information

NPI: 1699937623
Provider Name (Legal Business Name): MARIA ELISA VALDEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 02/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 N TEJON ST SUITE 200
COLORADO SPRINGS CO
80903-1142
US

IV. Provider business mailing address

402 N TEJON ST SUITE 200
COLORADO SPRINGS CO
80903-1142
US

V. Phone/Fax

Practice location:
  • Phone: 719-633-3850
  • Fax: 719-227-0840
Mailing address:
  • Phone: 719-633-3850
  • Fax: 719-227-0840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number57.013817
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: