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General NPI Number Information
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NPI Number | 1073509642
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Entity Type | Individual
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Provider Name | LISA MARIE VALLE D.O.
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Gender | Female
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Dates
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Enumeration Date | 09/20/2005
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Last Update Date | 05/09/2020
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Provider Practice Location Address
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Address Line | 1349 FRANKLIN ST
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City | SANTA MONICA
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State | CA
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Zip | 90404-2603
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Country | US
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Telephone | 424-231-7116
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Fax | 310-496-2762
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Provider Business Mailing Address
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Address Line | 1112 MONTANA AVE STE 378
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City | SANTA MONICA
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State | CA
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Zip | 90403-7218
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Country | US
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Telephone | 424-231-7116
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Fax | 310-496-2762
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 20A8420
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License Number State | CA
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