Provider Demographics
NPI:1902800394
Name:VALDIVIESO, JOSEFINA ANDREA (PA-C)
Entity Type:Individual
Prefix:
First Name:JOSEFINA
Middle Name:ANDREA
Last Name:VALDIVIESO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2775 SCHOENERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-7307
Mailing Address - Country:US
Mailing Address - Phone:610-861-8080
Mailing Address - Fax:610-807-0366
Practice Address - Street 1:2775 SCHOENERSVILLE RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7307
Practice Address - Country:US
Practice Address - Phone:610-861-8080
Practice Address - Fax:610-807-0366
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA050642363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
50068245OtherCAPITAL BLUE CROSS
1958671OtherHIGHMARK BLUE SHIELD
50068245OtherKEYSTONE HEALTH CENTRAL
438549OtherHEALTHAMERICA/HEALTHASSUR
1958671OtherHIGHMARK BLUE SHIELD
PA101825Medicare PIN