Healthcare Provider Details

I. General information

NPI: 1134467483
Provider Name (Legal Business Name): YOLANDA L VALDES PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2013
Last Update Date: 05/28/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12702 N IH 35
LIVE OAK TX
78233-2609
US

IV. Provider business mailing address

12702 N IH 35
LIVE OAK TX
78233-2609
US

V. Phone/Fax

Practice location:
  • Phone: 210-650-9660
  • Fax: 210-654-1432
Mailing address:
  • Phone: 210-650-9660
  • Fax: 210-654-1432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA08120
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: