Basic Information
| Provider Information | |||||||||
| NPI: | 1538170246 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VALDOVINOS | ||||||||
| FirstName: | MIRNA | ||||||||
| MiddleName: | G. | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 440 AIRPORT BLVD | ||||||||
| Address2: | |||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939053302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317578689 | ||||||||
| FaxNumber: | 8317573721 | ||||||||
| Practice Location | |||||||||
| Address1: | 799 FRONT ST | ||||||||
| Address2: | |||||||||
| City: | SOLEDAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939603017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316780881 | ||||||||
| FaxNumber: | 8316782803 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2006 | ||||||||
| LastUpdateDate: | 03/14/2012 | ||||||||
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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 | 14991 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.