Healthcare Provider Details

I. General information

NPI: 1932181971
Provider Name (Legal Business Name): NANCY VALDEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 54TH ST
LUBBOCK TX
79404
US

IV. Provider business mailing address

823 GATEWAY CENTER WAY
SAN DIEGO CA
92102-4541
US

V. Phone/Fax

Practice location:
  • Phone: 806-438-8005
  • Fax:
Mailing address:
  • Phone: 619-515-2300
  • Fax: 619-269-0674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC164884
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL5161
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: