Healthcare Provider Details

I. General information

NPI: 1962650093
Provider Name (Legal Business Name): JOHN G. VALLONE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 04/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19951 MARINER AVE SUITE 155
TORRANCE CA
90503-1672
US

IV. Provider business mailing address

19951 MARINER AVE SUITE 155
TORRANCE CA
90503-1672
US

V. Phone/Fax

Practice location:
  • Phone: 310-225-3244
  • Fax: 310-225-3244
Mailing address:
  • Phone: 310-225-3244
  • Fax: 310-225-3244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberA82455
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: