Healthcare Provider Details

I. General information

NPI: 1760482962
Provider Name (Legal Business Name): CHRISTINE VALDES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 02/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1069 BROADWAY
SAUGUS MA
01906-3210
US

IV. Provider business mailing address

1069 BROADWAY
SAUGUS MA
01906-3210
US

V. Phone/Fax

Practice location:
  • Phone: 781-233-1450
  • Fax:
Mailing address:
  • Phone: 781-233-1450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number214134
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number160018
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: