Provider Demographics
NPI:1619365327
Name:VALDEZ, GABRIEL
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:VALDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7613 SAGE OAK ST
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-2731
Mailing Address - Country:US
Mailing Address - Phone:541-778-9593
Mailing Address - Fax:
Practice Address - Street 1:CAMP CARROLL MEDICAL CLINIC
Practice Address - Street 2:UNIT 15375
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96260
Practice Address - Country:US
Practice Address - Phone:0505-753-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1123022363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant