MEDICARE: MR. RICARDO ALCIDES VALLE PA-C

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	363A00000X	Physician Assistant	PA08609	TX

General Provider Information

NPI Number	:	1538584677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICARDO ALCIDES VALLE PA-C

Provider Business Mailing Address
First Line	:	1623 AIRLINE DR
Second Line	:	SUITE 100-B
City	:	HOUSTON
State	:	TX
Zip	:	77009-3607
Country	:	US
Telephone Number	:	713-634-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1623 AIRLINE DR
Second Line	:	SUITE 100-B
City	:	HOUSTON
State	:	TX
Zip	:	77009-3607
Country	:	US
Telephone Number	:	713-634-1000
Fax Number	:

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

Provider Enumeration Date	:	02/26/2014
Last Update Date	:	09/25/2024

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