Healthcare Provider Details

I. General information

NPI: 1740262229
Provider Name (Legal Business Name): JUAN JORGE DEL VALLE JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JORGE DEL VALLE JR. MD

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 FLORIDA AVE
MODESTO CA
95350-4405
US

IV. Provider business mailing address

2116 E ORANGEBURG AVE # C
MODESTO CA
95355-3370
US

V. Phone/Fax

Practice location:
  • Phone: 209-578-1211
  • Fax:
Mailing address:
  • Phone: 209-589-1500
  • Fax: 209-521-0813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA81970
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: