MEDICARE: JUAN VALVERDE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	11519856	ZZ

General Provider Information

NPI Number	:	1306720941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN VALVERDE

Provider Business Mailing Address
First Line	:	3554 SUNSET LN UNIT 32
Second Line	:
City	:	SAN YSIDRO
State	:	CA
Zip	:	92173-4506
Country	:	US
Telephone Number	:	619-361-7103
Fax Number	:	619-785-3404

Provider Business Practice Location Address
First Line	:	12959 ABERDARE DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79928-4408
Country	:	US
Telephone Number	:	619-361-7103
Fax Number	:	619-785-3404

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2025
Last Update Date	:	08/05/2025

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Directions to “ JUAN VALVERDE ” Practice Location

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