Provider Demographics
NPI:1790010650
Name:VALLEJO-MOORE, RAQUEL (PA-C)
Entity Type:Individual
Prefix:MS
First Name:RAQUEL
Middle Name:
Last Name:VALLEJO-MOORE
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 1:2325 PERSHING DR
Mailing Address - Street 2:EL PASO, TEXAS 79903
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903-3608
Mailing Address - Country:US
Mailing Address - Phone:915-590-5600
Mailing Address - Fax:915-590-7367
Practice Address - Street 1:2325 PERSHING DR
Practice Address - Street 2:EL PASO, TEXAS 79903
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-3608
Practice Address - Country:US
Practice Address - Phone:915-590-5600
Practice Address - Fax:915-590-7367
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-12
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02871363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant