Healthcare Provider Details

I. General information

NPI: 1487371076
Provider Name (Legal Business Name): MIKE J VALDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 04/28/2023
Certification Date: 04/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3436 MARY ELDER RD NE
OLYMPIA WA
98506-5050
US

IV. Provider business mailing address

3436 MARY ELDER RD NE
OLYMPIA WA
98506-5050
US

V. Phone/Fax

Practice location:
  • Phone: 350-528-2590
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN61310431
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: