1083197768 NPI number — KARINA VALHALLA MANDRAGON PA-C

Table of content: KARINA VALHALLA MANDRAGON PA-C (NPI 1083197768)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083197768 NPI number — KARINA VALHALLA MANDRAGON PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANDRAGON
Provider First Name:
KARINA
Provider Middle Name:
VALHALLA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CAPREZ
Provider Other First Name:
KARINA
Provider Other Middle Name:
VALHALLA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1083197768
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 31001-4114
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91110-4114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-944-8920
Provider Business Mailing Address Fax Number:
509-227-7070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
212 E CENTRAL AVE STE 245
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99208-6289
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-489-2600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/10/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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