Provider Demographics
NPI:1699852616
Name:VALLER, DENALEE EATON (PA-C)
Entity Type:Individual
Prefix:
First Name:DENALEE
Middle Name:EATON
Last Name:VALLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42575 WASHINGTON ST
Mailing Address - Street 2:# A
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-8850
Mailing Address - Country:US
Mailing Address - Phone:760-360-0333
Mailing Address - Fax:760-360-1053
Practice Address - Street 1:42575 WASHINGTON ST
Practice Address - Street 2:# A
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-8850
Practice Address - Country:US
Practice Address - Phone:760-360-0333
Practice Address - Fax:760-360-1053
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18055363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ75958Medicare UPIN