MEDICARE: DR. SANDRA D VALE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	M8400	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	341417YL60	OTHER		MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2790068414	OTHER		MYUTMB 2790068414-COMMERCIAL NUMBER
2	TXB155391	OTHER		WELLMED NETWORKS INC

General Provider Information

NPI Number	:	1356545941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA D VALE MD

Provider Business Mailing Address
First Line	:	3031 W IH 10
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-5159
Country	:	US
Telephone Number	:	210-261-1000
Fax Number	:	210-731-8678

Provider Business Practice Location Address
First Line	:	1123 N MAIN AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-4740
Country	:	US
Telephone Number	:	210-261-3100
Fax Number	:	210-444-1828

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	06/19/2014

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Directions to “ DR. SANDRA D VALE MD” Practice Location

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