1215952056 NPI number — MIEL MARIE VALLEJO-BROOKS MD

Table of content: MIEL MARIE VALLEJO-BROOKS MD (NPI 1215952056)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215952056 NPI number — MIEL MARIE VALLEJO-BROOKS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VALLEJO-BROOKS
Provider First Name:
MIEL
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VALLEJO
Provider Other First Name:
MIEL
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215952056
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5280
Provider Second Line Business Mailing Address:
PATIENT BUSINESS SERVICES
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95150-5280
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-885-7200
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
751 S BASCOM AVE
Provider Second Line Business Practice Location Address:
OB/GYN DEPT
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95128-2604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-885-5550
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/13/2006

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: 207VX0000X , with the licence number:  A77518 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00A775180 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".