Healthcare Provider Details

I. General information

NPI: 1780311399
Provider Name (Legal Business Name): MR. JOHN RICO VALDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8610 54TH AVE
ELMHURST NY
11373-4335
US

IV. Provider business mailing address

8722 51ST AVE APT 1C
ELMHURST NY
11373-4183
US

V. Phone/Fax

Practice location:
  • Phone: 909-217-8007
  • Fax:
Mailing address:
  • Phone: 909-696-5773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number041410
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: