Provider Demographics
NPI:1144431636
Name:VALDEZ, MICHAEL SANTOS (PA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:SANTOS
Last Name:VALDEZ
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:2425 BABCOCK RD STE 108
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4899
Mailing Address - Country:US
Mailing Address - Phone:210-616-9400
Mailing Address - Fax:210-616-9402
Practice Address - Street 1:2425 BABCOCK RD STE 108
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4899
Practice Address - Country:US
Practice Address - Phone:210-616-9400
Practice Address - Fax:210-616-9402
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2012-08-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA00794363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP88873Medicare UPIN