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General NPI Number Information
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NPI Number | 1700540911
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Entity Type | Individual
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Provider Name | CHRISTOPHER DE VALLE CSA
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Gender | Male
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Dates
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Enumeration Date | 10/25/2021
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Last Update Date | 07/20/2024
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Provider Practice Location Address
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Address Line | 710 CYPRESS CREEK PKWY
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City | HOUSTON
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State | TX
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Zip | 77090-3402
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Country | US
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Telephone | 281-440-2150
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Fax |
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Provider Business Mailing Address
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Address Line | 21150 CORAL BLOSSOM LN
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City | CYPRESS
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State | TX
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Zip | 77433-5913
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Country | US
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Telephone | 281-913-9240
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Fax |
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 21-590
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License Number State |
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