Provider Demographics
NPI:1134467483
Name:VALDES, YOLANDA L (PA)
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:L
Last Name:VALDES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12702 N IH 35
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-2609
Mailing Address - Country:US
Mailing Address - Phone:210-650-9660
Mailing Address - Fax:210-654-1432
Practice Address - Street 1:12702 N IH 35
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-2609
Practice Address - Country:US
Practice Address - Phone:210-650-9660
Practice Address - Fax:210-654-1432
Is Sole Proprietor?:No
Enumeration Date:2013-01-22
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08120363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA08120OtherSTATE LICENSE