Healthcare Provider Details

I. General information

NPI: 1255147070
Provider Name (Legal Business Name): OLGA LYDIA VALDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2024
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 BOONVILLE RD
BRYAN TX
77808-2231
US

IV. Provider business mailing address

16570 HIGHWAY 6 S
COLLEGE STATION TX
77845-8460
US

V. Phone/Fax

Practice location:
  • Phone: 979-775-0911
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number1079526
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: