MEDICARE: ELISA JOY VALE RN

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	163W00000X	Registered Nurse	95223946	CA

General Provider Information

NPI Number	:	1659984151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISA JOY VALE RN

Provider Business Mailing Address
First Line	:	5843 MILDRED ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-1644
Country	:	US
Telephone Number	:	925-338-3250
Fax Number	:

Provider Business Practice Location Address
First Line	:	5843 MILDRED ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-1644
Country	:	US
Telephone Number	:	925-338-3250
Fax Number	:

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

Provider Enumeration Date	:	08/25/2020
Last Update Date	:	08/25/2020

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