MEDICARE: JENNIFER NICOLE VALLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	40557	TX
2	390200000X	Student in an Organized Health Care Education/Training Program		TX

General Provider Information

NPI Number	:	1114628781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER NICOLE VALLE

Provider Business Mailing Address
First Line	:	8210 FLOYD CURL DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3923
Country	:	US
Telephone Number	:	210-450-3700
Fax Number	:

Provider Business Practice Location Address
First Line	:	4707 WURZBACH RD APT 1207
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-1108
Country	:	US
Telephone Number	:	956-456-4436
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2023
Last Update Date	:	07/24/2024

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Directions to “ JENNIFER NICOLE VALLE ” Practice Location

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