Healthcare Provider Details

I. General information

NPI: 1992936488
Provider Name (Legal Business Name): JOSE RUBEN VALLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 9TH ST N STE 100
NAPLES FL
34102-5886
US

IV. Provider business mailing address

311 9TH ST N STE 100
NAPLES FL
34102-5886
US

V. Phone/Fax

Practice location:
  • Phone: 239-624-8250
  • Fax: 239-430-7824
Mailing address:
  • Phone: 239-624-8250
  • Fax: 239-430-7824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number13813
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME128149
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberME128149
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: