Healthcare Provider Details

I. General information

NPI: 1306857677
Provider Name (Legal Business Name): LATICIA VALLE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/05/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 SOUTH AVE SUITE 207
ROCHESTER NY
14620-2763
US

IV. Provider business mailing address

1000 SOUTH AVE BOX 108
ROCHESTER NY
14620-2733
US

V. Phone/Fax

Practice location:
  • Phone: 585-341-6775
  • Fax:
Mailing address:
  • Phone: 585-341-0209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number233972
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: