Lydia Marie Vallesillas, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

52345 Issued in CA

Practice address

7300 N Fresno St
Fresno, CA 93720-2941

Phone

(559) 448-4500

NPI assigned

Sep 1, 2015

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Ms. Lydia Marie Gonzales Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1441065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441065600000",
    "number": "1942677489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 890741",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925890741",
            "telephone_number": "951-225-9596",
            "fax_number": "951-225-9596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7300 N FRESNO ST",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937202941",
            "telephone_number": "559-448-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VALLESILLAS",
        "first_name": "LYDIA",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-09-01",
        "last_updated": "2015-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "52345",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LYDIA",
            "last_name": "GONZALES",
            "middle_name": "MARIE",
            "prefix": "MS.",
            "credential": "RCP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Patricia Vallejo
• Joseph Vallejos, BCBA
• Randy S Vallembois, CPO
• Francisco Javier Valles
• Stephanie Valleser, NP
• Valley Adult Day Health Care Center
• Valley Cardiac Surgery Medical Group
• Valley Care Residential
• Valley Care Residential
• Valley Care Residential

• Physician Assistant in Fresno, CA
• Providers in Fresno, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.