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General NPI Number Information
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NPI Number | 1053461285
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Entity Type | Individual
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Provider Name | JOSE ANGEL VALDIVIA PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 02/14/2011
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Provider Practice Location Address
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Address Line | 10401 W THUNDERBIRD BLVD
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City | SUN CITY
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State | AZ
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Zip | 85351-3004
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Country | US
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Telephone | 623-876-5366
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Fax | 866-552-8029
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Provider Business Mailing Address
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Address Line | 10401 W THUNDERBIRD BLVD
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City | SUN CITY
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State | AZ
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Zip | 85351-3004
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Country | US
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Telephone | 623-876-5366
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Fax | 866-552-8029
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 2145
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License Number State | AZ
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