Active NPI
Walter Valdevilla Laurel, M.D.
- Pediatrics Physician
- Fresno, CA
National Provider Identifier
1588911960
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- A134336
- Practice address
- 2760 S Elm Ave
Fresno, CA 93706-5435 - Phone
- (559) 457-5300
- Fax
- (559) 457-5390
- NPI assigned
- Aug 5, 2012
- Last updated
- Oct 14, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | A134336 | CA | Primary |
Addresses
Primary practice location
2760 S Elm Ave
Fresno, CA 93706-5435
Mailing address
PO Box 1559
Bakersfield, CA 93302-1559
Phone (661) 635-3050
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A134336 | CA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1344124800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1602633600000",
"number": "1588911960",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1559",
"city": "BAKERSFIELD",
"state": "CA",
"postal_code": "933021559",
"telephone_number": "661-635-3050",
"fax_number": "559-457-6990"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2760 S ELM AVE",
"city": "FRESNO",
"state": "CA",
"postal_code": "937065435",
"telephone_number": "559-457-5300",
"fax_number": "559-457-5390"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAUREL",
"first_name": "WALTER",
"middle_name": "VALDEVILLA",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-08-05",
"last_updated": "2020-10-14",
"certification_date": "2020-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "A134336",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fresno, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.