1689803215 NPI number — JEANNETTE DEL VALLE MD, INC.

Table of content: (NPI 1689803215)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689803215 NPI number — JEANNETTE DEL VALLE MD, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEANNETTE DEL VALLE MD, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689803215
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 568
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUNCIE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47308-0568
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-284-0493
Provider Business Mailing Address Fax Number:
765-284-2434

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
769 MEDICAL CENTER CT
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91911-6602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-421-3313
Provider Business Practice Location Address Fax Number:
619-421-3315
Provider Enumeration Date:
07/02/2009

Additional Information

Authorized Official

Authorized Official Last Name:
DEL VALLE
Authorized Official First Name:
JEANNETTE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
619-421-3313

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  A42660 , 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: 00A426600 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1952370074 . This is a "TYPE I NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: WA42660G . This is a "MEDICARE ID-TYPE UNSPECIFIED" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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