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General NPI Number Information
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NPI Number | 1700580552
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Entity Type | Individual
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Provider Name | IVAN VALDES
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Gender | Male
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Dates
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Enumeration Date | 03/27/2023
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 2501 CORNERSTONE BLVD
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City | EDINBURG
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State | TX
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Zip | 78539-8463
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Country | US
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Telephone | 956-329-7730
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Fax |
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Provider Business Mailing Address
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Address Line | 4708 SONORA AVE
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City | MCALLEN
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State | TX
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Zip | 78503-8137
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Country | US
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Telephone | 956-525-1491
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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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 | 41517
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License Number State | TX
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