Healthcare Provider Details

I. General information

NPI: 1336702554
Provider Name (Legal Business Name): AL VALMADRID MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5950 UNIVERSITY AVE STE 120
WEST DES MOINES IA
50266-8232
US

IV. Provider business mailing address

PO BOX 424
DES MOINES IA
50302-0424
US

V. Phone/Fax

Practice location:
  • Phone: 515-875-9744
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD-56800
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: