Basic Information
| Provider Information | |||||||||
| NPI: | 1174048367 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VALDEZ | ||||||||
| FirstName: | MEDEA | ||||||||
| MiddleName: | YVONNE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 536 RICHARD PL | ||||||||
| Address2: | |||||||||
| City: | WYCKOFF | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074811703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018191682 | ||||||||
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| Practice Location | |||||||||
| Address1: | 190 BALDWIN RD STE B | ||||||||
| Address2: | |||||||||
| City: | PARSIPPANY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070542006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9738820444 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2017 | ||||||||
| LastUpdateDate: | 08/08/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 25MP00048900 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.