Provider Demographics
NPI:1538170246
Name:VALDOVINOS, MIRNA G (PA)
Entity type:Individual
Prefix:
First Name:MIRNA
Middle Name:G
Last Name:VALDOVINOS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:440 AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93905-3302
Mailing Address - Country:US
Mailing Address - Phone:831-757-8689
Mailing Address - Fax:831-757-3721
Practice Address - Street 1:799 FRONT ST
Practice Address - Street 2:
Practice Address - City:SOLEDAD
Practice Address - State:CA
Practice Address - Zip Code:93960-3017
Practice Address - Country:US
Practice Address - Phone:831-678-0881
Practice Address - Fax:831-678-2803
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA14991363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant