Healthcare Provider Details

I. General information

NPI: 1265403158
Provider Name (Legal Business Name): ALFREDO VALLESTEROS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3208 HERSHBERGER RD NW
ROANOKE VA
24017-1842
US

IV. Provider business mailing address

1906 BELLEVIEW AVE SE
ROANOKE VA
24014-1838
US

V. Phone/Fax

Practice location:
  • Phone: 540-366-5248
  • Fax:
Mailing address:
  • Phone: 540-981-7000
  • Fax: 540-853-0931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101221482
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101221482
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number0101221482
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: