Healthcare Provider Details

I. General information

NPI: 1497936876
Provider Name (Legal Business Name): IVETTE VALLE MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 04/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 W 49TH PL SUITE 400-A
HIALEAH FL
33012-3197
US

IV. Provider business mailing address

1435 W 49TH PL SUITE 400-A
HIALEAH FL
33012-3197
US

V. Phone/Fax

Practice location:
  • Phone: 305-818-5637
  • Fax: 305-818-5639
Mailing address:
  • Phone: 305-818-5637
  • Fax: 305-818-5639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. IVETTE VALLE
Title or Position: OWNER
Credential: MD
Phone: 305-818-5637