Healthcare Provider Details

I. General information

NPI: 1497963698
Provider Name (Legal Business Name): ANTHONY ALEXIS VALLARINO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2007
Last Update Date: 04/16/2020
Certification Date: 04/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3080 SAM RAYBURN HIGHWAY
MELISSA TX
75454
US

IV. Provider business mailing address

3080 SAM RAYBURN HIGHWAY
MELISSA TX
75454
US

V. Phone/Fax

Practice location:
  • Phone: 469-796-4125
  • Fax: 469-796-4124
Mailing address:
  • Phone: 469-796-4125
  • Fax: 469-796-4124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM5557
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: