Provider Demographics
NPI:1659882678
Name:VALLES, ARMANDO JOSE (SA-C)
Entity Type:Individual
Prefix:
First Name:ARMANDO
Middle Name:JOSE
Last Name:VALLES
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7614 MOSS BROOK DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78255-1304
Mailing Address - Country:US
Mailing Address - Phone:210-488-4890
Mailing Address - Fax:
Practice Address - Street 1:7614 MOSS BROOK DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78255-1304
Practice Address - Country:US
Practice Address - Phone:210-488-4890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant