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NPI Code Detail

MEDICARE: AVA DIANE VALDEZ PAC

MEDICARE: AVA DIANE VALDEZ PAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant085-001567IL

General Provider Information

NPI Number : 1376717439
Entity Type Code : Individual
Provider Name (Legal Business Name) : AVA DIANE VALDEZ PAC
Provider Business Mailing Address
First Line : 915 13TH AVE N
Second Line :
City : CLINTON
State : IA
Zip : 52732-5067
Country : US
Telephone Number : 563-243-2511
Fax Number : 563-243-0817
Provider Business Practice Location Address
First Line : 635 E LINCOLNWAY
Second Line :
City : MORRISON
State : IL
Zip : 61270-2963
Country : US
Telephone Number : 815-772-7491
Fax Number : 815-772-7891
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2008
Last Update Date : 01/02/2015

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Directions to “ AVA DIANE VALDEZ PAC” Practice Location

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