Healthcare Provider Details

I. General information

NPI: 1700011335
Provider Name (Legal Business Name): RACHEL VALLEJO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 PONCE DE LEON BLVD STE 607
CORAL GABLES FL
33134-2074
US

IV. Provider business mailing address

747 PONCE DE LEON BLVD STE 607
CORAL GABLES FL
33134-2074
US

V. Phone/Fax

Practice location:
  • Phone: 305-787-7780
  • Fax:
Mailing address:
  • Phone: 305-787-7780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberME107591
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME 107591
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: