MEDICARE: M R VALLES HEALTHCARE P C INC

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	2084P0800X	Psychiatry Physician	10710	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	V104918	OTHER	NV	MEDICARE GROUP PTAN

General Provider Information

NPI Number	:	1538226931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M R VALLES HEALTHCARE P C INC

Provider Business Mailing Address
First Line	:	9653 MESA RIDGE CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129
Country	:	US
Telephone Number	:	702-232-4210
Fax Number	:	702-453-7005

Provider Business Practice Location Address
First Line	:	9653 MESA RIDGE CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129
Country	:	US
Telephone Number	:	702-232-4210
Fax Number	:	702-453-7005

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN P VALLES
Credential	:	M.D.
Telephone Number	:	702-797-0588

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	03/09/2015

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