Provider Demographics
NPI:1336321116
Name:GARCIA, MANUEL VALADEZ (MSPAS)
Entity Type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:VALADEZ
Last Name:GARCIA
Suffix:
Gender:M
Credentials:MSPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1411
Mailing Address - Street 2:
Mailing Address - City:SHAFTER
Mailing Address - State:CA
Mailing Address - Zip Code:93263
Mailing Address - Country:US
Mailing Address - Phone:323-842-3643
Mailing Address - Fax:
Practice Address - Street 1:217 W KERN AVE
Practice Address - Street 2:
Practice Address - City:MC FARLAND
Practice Address - State:CA
Practice Address - Zip Code:93250-1360
Practice Address - Country:US
Practice Address - Phone:661-792-3038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19517363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant