Provider Demographics
NPI:1003188368
Name:DEL VALLE, SANDRA JENNIFER (PA)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JENNIFER
Last Name:DEL VALLE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1003 E FLORIDA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4510
Mailing Address - Country:US
Mailing Address - Phone:951-652-2252
Mailing Address - Fax:951-658-6476
Practice Address - Street 1:1003 E FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4510
Practice Address - Country:US
Practice Address - Phone:951-652-2252
Practice Address - Fax:951-658-6476
Is Sole Proprietor?:No
Enumeration Date:2012-02-02
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21800363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical