Provider Demographics
NPI:1083197768
Name:MANDRAGON, KARINA VALHALLA (PA-C)
Entity type:Individual
Prefix:
First Name:KARINA
Middle Name:VALHALLA
Last Name:MANDRAGON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KARINA
Other - Middle Name:VALHALLA
Other - Last Name:CAPREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0421
Mailing Address - Country:US
Mailing Address - Phone:509-944-8920
Mailing Address - Fax:509-227-7070
Practice Address - Street 1:16528 E DESMET CT
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-3522
Practice Address - Country:US
Practice Address - Phone:509-944-8920
Practice Address - Fax:509-227-7070
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant