MEDICARE: ANNA VALLES P.A.-C

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
1	363A00000X	Physician Assistant	PA05100	TX

General Provider Information

NPI Number	:	1811067374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA VALLES P.A.-C

Provider Business Mailing Address
First Line	:	1350 S MAIN ST STE 3200
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-7669
Country	:	US
Telephone Number	:	817-702-8400
Fax Number	:

Provider Business Practice Location Address
First Line	:	1741 E BARDIN RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76018-4836
Country	:	US
Telephone Number	:	817-702-8700
Fax Number	:	817-702-4243

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	10/24/2019

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Directions to “ ANNA VALLES P.A.-C” Practice Location

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