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General NPI Number Information
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NPI Number | 1215017769
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Entity Type | Individual
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Provider Name | MAURICIO VALDES M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 09/30/2015
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Provider Practice Location Address
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Address Line | 136 S BROADWAY
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City | YONKERS
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State | NY
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Zip | 10701-4008
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Country | US
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Telephone | 914-965-0621
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Fax | 914-965-2040
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Provider Business Mailing Address
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Address Line | 75A LAKE RD 155
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City | CONGERS
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State | NY
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Zip | 10920-2323
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Country | US
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Telephone | 914-965-0621
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 216884
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License Number State | NY
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