Provider Demographics
NPI:1073836151
Name:DJOJOSEPARTO, VALLERIE GABRIELLA (PA-C)
Entity Type:Individual
Prefix:
First Name:VALLERIE
Middle Name:GABRIELLA
Last Name:DJOJOSEPARTO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11420 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-7056
Mailing Address - Country:US
Mailing Address - Phone:718-459-8460
Mailing Address - Fax:718-459-8464
Practice Address - Street 1:11420 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-7056
Practice Address - Country:US
Practice Address - Phone:718-459-8460
Practice Address - Fax:718-459-8464
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013551363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical