Provider Demographics
NPI:1407911480
Name:VALLES, LINDA C (NP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:C
Last Name:VALLES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5734 CANYON VIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-5503
Mailing Address - Country:US
Mailing Address - Phone:530-872-2000
Mailing Address - Fax:530-876-7969
Practice Address - Street 1:5734 CANYON VIEW DRIVE
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-5503
Practice Address - Country:US
Practice Address - Phone:530-872-2000
Practice Address - Fax:530-876-7969
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 14473363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMV1408891OtherDEA#