Individual
JONATHON MICHAEL LAVALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1423 E ROOSEVELT AVE, GRANTS, NM 87020-2245
(505) 287-6500
(505) 287-5393
Mailing address
1423 E ROOSEVELT AVE, GRANTS, NM 87020-2245
(505) 363-5126
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2013-0089
NM
Other
Enumeration date
01/12/2014
Last updated
01/12/2014
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