Provider Demographics
NPI:1609386903
Name:VALLES, YOLANDA PATRICIA X
Entity Type:Individual
Prefix:MS
First Name:YOLANDA
Middle Name:PATRICIA
Last Name:VALLES
Suffix:X
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:PO BOX 4644
Mailing Address - Street 2:
Mailing Address - City:BLUE JAY
Mailing Address - State:CA
Mailing Address - Zip Code:92317-4644
Mailing Address - Country:US
Mailing Address - Phone:909-338-3222
Mailing Address - Fax:
Practice Address - Street 1:24028 LAKE DRIVE
Practice Address - Street 2:
Practice Address - City:CRESTILINE
Practice Address - State:CA
Practice Address - Zip Code:92325
Practice Address - Country:US
Practice Address - Phone:909-338-3222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator