Healthcare Provider Details

I. General information

NPI: 1336188424
Provider Name (Legal Business Name): LUIS F VALLES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 06/03/2020
Certification Date: 06/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 HAVEN ST
READING MA
01867-2929
US

IV. Provider business mailing address

201 STETSON DR
CHARLOTTE NC
28262-3364
US

V. Phone/Fax

Practice location:
  • Phone: 781-944-2050
  • Fax:
Mailing address:
  • Phone: 704-596-5606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number71266
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number239598
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: