Provider Demographics
NPI:1407194343
Name:VALLES, SYLVIA GRACE
Entity Type:Individual
Prefix:MS
First Name:SYLVIA
Middle Name:GRACE
Last Name:VALLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 NW 196TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-3640
Mailing Address - Country:US
Mailing Address - Phone:405-924-7014
Mailing Address - Fax:
Practice Address - Street 1:2325 NW 196TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-3640
Practice Address - Country:US
Practice Address - Phone:405-924-7014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker