Individual
JACK SAMUEL VALDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
114 BRIDLE TRL, PUEBLO, CO 81005-3031
(719) 406-1958
Mailing address
114 BRIDLE TRL, PUEBLO, CO 81005-3031
(719) 406-1958
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
9923486
CO
Other
Enumeration date
01/15/2024
Last updated
01/15/2024
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