Healthcare Provider Details

I. General information

NPI: 1578660684
Provider Name (Legal Business Name): MELCHIOR PETER VALLONE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5129 GARFIELD ST
LA MESA CA
91941-5103
US

IV. Provider business mailing address

5129 GARFIELD ST
LA MESA CA
91941-5103
US

V. Phone/Fax

Practice location:
  • Phone: 619-465-3200
  • Fax: 619-465-3700
Mailing address:
  • Phone: 619-465-3200
  • Fax: 619-465-3700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE2201
License Number StateCA

VIII. Authorized Official

Name: DR. MELCHIOR PETER VALLONE
Title or Position: OWNER
Credential: D.P.M.
Phone: 619-465-3200