Healthcare Provider Details

I. General information

NPI: 1831251024
Provider Name (Legal Business Name): ROBERT J. VALLONE, D.P.M., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 08/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3363 4TH AVE
SAN DIEGO CA
92103-5703
US

IV. Provider business mailing address

3363 4TH AVE
SAN DIEGO CA
92103-5703
US

V. Phone/Fax

Practice location:
  • Phone: 619-295-9494
  • Fax: 619-295-9714
Mailing address:
  • Phone: 619-295-9494
  • Fax: 619-295-9714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberE2715
License Number StateCA

VIII. Authorized Official

Name: DR. ROBERT J VALLONE
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 619-295-9494