Healthcare Provider Details

I. General information

NPI: 1023126505
Provider Name (Legal Business Name): CEASAR ANTHONY VALLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2006
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 N BELLFLOWER BLVD STE 115
LONG BEACH CA
90815-1100
US

IV. Provider business mailing address

2700 N BELLFLOWER BLVD STE 115
LONG BEACH CA
90815-1100
US

V. Phone/Fax

Practice location:
  • Phone: 562-425-1275
  • Fax:
Mailing address:
  • Phone: 562-425-1275
  • Fax: 562-280-7417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA068619
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: