Provider Demographics
NPI:1124051875
Name:VALES-PREVAL, MARIE YVES (PA-C)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:YVES
Last Name:VALES-PREVAL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 W OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE A4
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33311-1243
Mailing Address - Country:US
Mailing Address - Phone:954-484-9590
Mailing Address - Fax:
Practice Address - Street 1:2901 W OAKLAND PARK BLVD
Practice Address - Street 2:SUITE A4
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33311-1243
Practice Address - Country:US
Practice Address - Phone:954-484-9590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103470363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant