Healthcare Provider Details

I. General information

NPI: 1932973765
Provider Name (Legal Business Name): BETH MARIE DEL VALLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2624 TILDEN DR
PLANO TX
75074
US

IV. Provider business mailing address

2624 TILDEN DR
PLANO TX
75074
US

V. Phone/Fax

Practice location:
  • Phone: 972-835-6311
  • Fax:
Mailing address:
  • Phone: 972-835-6311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number93175
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: