Individual
YENISLEYDI VALDIVIA VILLAVICENCIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3201 W PEORIA AVE STE A202, PHOENIX, AZ 85029-4602
(602) 863-1716
Mailing address
3201 W PEORIA AVE STE A202, PHOENIX, AZ 85029-4602
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10340
AZ
363A00000X
Physician Assistant
TPPA543
FL
Other
Enumeration date
03/15/2023
Last updated
05/30/2024
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