MEDICARE: JENNIFER VALA

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	363LF0000X	Family Nurse Practitioner	AP143103	TX

General Provider Information

NPI Number	:	1437786555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER VALA

Provider Business Mailing Address
First Line	:	277 BUDDY GANEM DR STE A
Second Line	:
City	:	PORTLAND
State	:	TX
Zip	:	78374-3202
Country	:	US
Telephone Number	:	361-777-3900
Fax Number	:	361-413-0274

Provider Business Practice Location Address
First Line	:	5802 SARATOGA BLVD STE 120
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78414-4253
Country	:	US
Telephone Number	:	361-991-5437
Fax Number	:	361-991-5442

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

Provider Enumeration Date	:	03/26/2020
Last Update Date	:	03/26/2020

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Directions to “ JENNIFER VALA ” Practice Location

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