Provider Demographics
NPI:1972114387
Name:VALLES, EMMANUELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:EMMANUELLE
Middle Name:
Last Name:VALLES
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 1:10436 SW 127TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-3527
Mailing Address - Country:US
Mailing Address - Phone:305-987-6677
Mailing Address - Fax:
Practice Address - Street 1:1951 SW 172ND AVE STE 305
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-5614
Practice Address - Country:US
Practice Address - Phone:954-362-2720
Practice Address - Fax:954-362-2762
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9112887363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant