Provider Demographics
NPI:1164404034
Name:VALDEZ, XAVIER IDELFONSO (MPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:XAVIER
Middle Name:IDELFONSO
Last Name:VALDEZ
Suffix:
Gender:M
Credentials:MPAS, PA-C
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Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:PO BOX 104
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91944-0104
Mailing Address - Country:US
Mailing Address - Phone:619-328-3025
Mailing Address - Fax:619-312-0528
Practice Address - Street 1:4561 DICKEY DR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-5735
Practice Address - Country:US
Practice Address - Phone:619-328-3025
Practice Address - Fax:619-312-0528
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA19287363AS0400X
TXPA04666363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical