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NPI Code Detail

MEDICARE: JOSE VALLE D.O.

MEDICARE: JOSE VALLE D.O.
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
1122300000XDentist019023211IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1019023211OTHERILSTATE LICENSE

General Provider Information

NPI Number : 1780800391
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSE VALLE D.O.
Provider Business Mailing Address
First Line : 12006 S HAMLIN AVE
Second Line :
City : ALSIP
State : IL
Zip : 60803-1216
Country : US
Telephone Number : 773-284-4044
Fax Number :
Provider Business Practice Location Address
First Line : 1536 VINCENNES AVE
Second Line :
City : CHICAGO HEIGHTS
State : IL
Zip : 60411-3458
Country : US
Telephone Number : 708-709-1044
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2007
Last Update Date : 07/08/2007

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