Provider Demographics
NPI:1831345719
Name:CARMONA, ELIZABETH VALDIVIA (PA-C)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:VALDIVIA
Last Name:CARMONA
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 1:300 LABOR ST
Mailing Address - Street 2:APT 4208
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78210-1092
Mailing Address - Country:US
Mailing Address - Phone:210-534-9087
Mailing Address - Fax:
Practice Address - Street 1:104 BABCOCK RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-2900
Practice Address - Country:US
Practice Address - Phone:210-736-2244
Practice Address - Fax:210-736-0011
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04409363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant