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NPI Code Detail

MEDICARE: M R VALLES HEALTHCARE P C INC

MEDICARE: M R VALLES HEALTHCARE P C INC
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
12084P0800XPsychiatry Physician10710NV

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1V104918OTHERNVMEDICARE GROUP PTAN

General Provider Information

NPI Number : 1538226931
Entity Type Code : Organization
Provider Name (Legal Business Name) : M R VALLES HEALTHCARE P C INC
Provider Business Mailing Address
First Line : 9653 MESA RIDGE CT
Second Line :
City : LAS VEGAS
State : NV
Zip : 89129
Country : US
Telephone Number : 702-232-4210
Fax Number : 702-453-7005
Provider Business Practice Location Address
First Line : 9653 MESA RIDGE CT
Second Line :
City : LAS VEGAS
State : NV
Zip : 89129
Country : US
Telephone Number : 702-232-4210
Fax Number : 702-453-7005
Authorized Official
Title or Position : PRESIDENT
Name : JOHN P VALLES
Credential : M.D.
Telephone Number : 702-797-0588
Provider Enumeration Date : 01/03/2007
Last Update Date : 03/09/2015

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