Provider Demographics
NPI:1861709404
Name:VALDIZAN-GARCIA, MARIA CONCEPCION (FNP)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:CONCEPCION
Last Name:VALDIZAN-GARCIA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 E 1200 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-2711
Mailing Address - Country:US
Mailing Address - Phone:210-875-4486
Mailing Address - Fax:
Practice Address - Street 1:8446 S HARRISON ST
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-3501
Practice Address - Country:US
Practice Address - Phone:801-417-0131
Practice Address - Fax:801-255-5814
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX718791363LF0000X
UT8227016-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily