Individual
XAVIER IDELFONSO VALDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPAS, PA-C
Contact information
Practice address
4561 DICKEY DR, LA MESA, CA 91941-5735
(619) 328-3025
(619) 312-0528
Mailing address
PO BOX 104, LA MESA, CA 91944-0104
(619) 328-3025
(619) 312-0528
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA04666
TX
363AS0400X
Surgical Physician Assistant
PA19287
CA
Other
Enumeration date
11/16/2005
Last updated
12/01/2021
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