Provider Demographics
NPI:1093768855
Name:VALLBONA, CARLOS FERNANDO (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:FERNANDO
Last Name:VALLBONA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:256 LANDIS AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-2650
Mailing Address - Country:US
Mailing Address - Phone:619-426-9600
Mailing Address - Fax:619-426-4112
Practice Address - Street 1:256 LANDIS AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2650
Practice Address - Country:US
Practice Address - Phone:619-426-9600
Practice Address - Fax:619-426-4112
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA18386363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant