Healthcare Provider Details

I. General information

NPI: 1194460121
Provider Name (Legal Business Name): LUIS DEL VALLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 BOSTON AVE STE 206
ALTAMONTE SPRINGS FL
32701-4712
US

IV. Provider business mailing address

1707 ORLANDO CENTRAL PKWY STE 480
ORLANDO FL
32809-5785
US

V. Phone/Fax

Practice location:
  • Phone: 407-382-9079
  • Fax: 407-964-1274
Mailing address:
  • Phone: 407-382-9079
  • Fax: 407-964-1274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: