Provider Demographics
NPI:1578308086
Name:CARDOSO DE OLIVEIRA JUNIOR, VALDEONE
Entity type:Individual
Prefix:MR
First Name:VALDEONE
Middle Name:
Last Name:CARDOSO DE OLIVEIRA JUNIOR
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:VALDEONE JR
Other - Middle Name:
Other - Last Name:CARDOSO DE OLIVEIRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OLIVER
Mailing Address - Street 1:1127 VILLAGE DR APT 9
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-3442
Mailing Address - Country:US
Mailing Address - Phone:650-504-9682
Mailing Address - Fax:
Practice Address - Street 1:1127 VILLAGE DR APT 9
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-3442
Practice Address - Country:US
Practice Address - Phone:650-504-9682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96825225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist