Provider Demographics
NPI:1609122068
Name:VALADEZ, PRISCILLA ANN
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:ANN
Last Name:VALADEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PRISCILLA
Other - Middle Name:ANN
Other - Last Name:VILLANUEVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:126 GARNER ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78237-4022
Mailing Address - Country:US
Mailing Address - Phone:210-328-2292
Mailing Address - Fax:
Practice Address - Street 1:126 GARNER ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78237-4022
Practice Address - Country:US
Practice Address - Phone:210-328-2292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43690-PT09246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy