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General NPI Number Information
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NPI Number | 1366139230
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Entity Type | Individual
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Provider Name | VALERIE CARRIZALES PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/20/2023
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Last Update Date | 09/16/2024
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Provider Practice Location Address
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Address Line | 9556 MANCHESTER RD
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City | SAINT LOUIS
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State | MO
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Zip | 63119-1313
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Country | US
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Telephone |
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Fax |
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Provider Business Mailing Address
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Address Line | 14666 CHESTERFIELD TRAILS DR
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City | CHESTERFIELD
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State | MO
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Zip | 63017-5631
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Country | US
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Telephone | 314-598-8006
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 1224649
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License Number State | MO
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