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General NPI Number Information
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NPI Number | 1861882987
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Entity Type | Organization
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Legal Business Name | ADRIANA M VALDOVINOS, MD
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Dates
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Enumeration Date | 01/27/2015
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Last Update Date | 01/27/2015
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Provider Practice Location Address
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Address Line | 4502 E AVENUE S
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City | PALMDALE
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State | CA
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Zip | 93552-4480
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Country | US
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Telephone | 661-533-7802
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Fax | 661-533-7809
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Provider Business Mailing Address
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Address Line | 4502 E AVENUE S
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City | PALMDALE
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State | CA
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Zip | 93552-4480
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Country | US
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Telephone | 661-533-7802
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Fax | 661-533-7809
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Authorized Official
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Title or Position | PER DIEM PHYSICIAN
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Name | MRS. ADRIANA M VALDOVINOS-CAMPA
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Credential | MD
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Telephone | 661-533-7802
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1800X
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Taxonomy Name | Corporate Health Clinic/Center
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License Number | A062181
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | A062181
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License Number State | CA
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