Provider Demographics
NPI:1134720972
Name:VALENZUELA PORFIDO, ALESSANDRA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:ALESSANDRA
Middle Name:MARIE
Last Name:VALENZUELA PORFIDO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALESSANDRA
Other - Middle Name:MARIE
Other - Last Name:PORFIDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:737 W CHILDS AVE
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95341-6805
Mailing Address - Country:US
Mailing Address - Phone:866-682-4842
Mailing Address - Fax:
Practice Address - Street 1:1510 FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4437
Practice Address - Country:US
Practice Address - Phone:866-682-4842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58758363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant