Healthcare Provider Details

I. General information

NPI: 1780724492
Provider Name (Legal Business Name): CASIMIRA DOMINGA VALDEZ L.M.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2402 BROADWAY ST
VANCOUVER WA
98663-3229
US

IV. Provider business mailing address

2716 E 13TH ST
VANCOUVER WA
98661-4799
US

V. Phone/Fax

Practice location:
  • Phone: 360-241-6630
  • Fax: 360-567-0620
Mailing address:
  • Phone: 360-826-7266
  • Fax: 360-826-7266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberWA00020974
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: