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General NPI Number Information
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NPI Number | 1295101640
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Entity Type | Organization
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Legal Business Name | VALDEZ FAMILY DENTISTRY
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Dates
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Enumeration Date | 08/19/2015
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Last Update Date | 08/19/2015
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Provider Practice Location Address
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Address Line | 4129 RIVERSIDE DR
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City | CHINO
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State | CA
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Zip | 91710
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Country | US
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Telephone | 909-591-9211
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Fax | 909-613-0601
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Provider Business Mailing Address
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Address Line | 4129 RIVERSIDE DR.
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City | CHINO
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State | CA
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Zip | 91710
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Country | US
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Telephone | 909-591-9211
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Fax | 909-613-0601
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Authorized Official
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Title or Position | DENTIST
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Name | DR. VIVIAN MONIQUE VALDEZ
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Credential | D.M.D
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Telephone | 909-591-9211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 61143
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 61102
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License Number State | CA
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