Provider Demographics
NPI:1255046470
Name:VALDEZ, ALYSSA RAQUEL
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:RAQUEL
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4407 BEE CAVES RD. STE 422
Mailing Address - Street 2:
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746
Mailing Address - Country:US
Mailing Address - Phone:512-469-0535
Mailing Address - Fax:512-387-3515
Practice Address - Street 1:4407 BEE CAVES RD. STE 422
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5532
Practice Address - Country:US
Practice Address - Phone:512-469-0535
Practice Address - Fax:512-387-3515
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1112550363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health