Provider Demographics
NPI:1174352058
Name:VALLES, XENIA DAFFODIL CLAVANO
Entity type:Individual
Prefix:
First Name:XENIA DAFFODIL
Middle Name:CLAVANO
Last Name:VALLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5721 PEBBLE ROCK DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-5150
Mailing Address - Country:US
Mailing Address - Phone:702-326-0838
Mailing Address - Fax:
Practice Address - Street 1:5721 PEBBLE ROCK DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-5150
Practice Address - Country:US
Practice Address - Phone:702-326-0838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV881446363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily