Healthcare Provider Details

I. General information

NPI: 1689701567
Provider Name (Legal Business Name): FLORENTINO VALDEZ PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 HANNA AVE STE 1
CORCORAN CA
93212-2314
US

IV. Provider business mailing address

1479 W LACEY BLVD
HANFORD CA
93230-5906
US

V. Phone/Fax

Practice location:
  • Phone: 559-992-8200
  • Fax: 559-992-8673
Mailing address:
  • Phone: 559-583-4617
  • Fax: 559-583-4625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number18533
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: